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PubMed2000

Splints and stress transmission to teeth: an in vitro experiment.

OBJECTIVE: To determine the influence of hard and soft splints with two thicknesses on the stress transmission to the tooth supporting the splint and the opposite tooth. METHODS: Continuous vertical forces up to 500N were applied to two opposite first molar phantom teeth using a universal loading machine. Deformation was detected by strain gauges attached to the cervical area of the buccal and lingual aspects of the lower tooth. Strain, as a function of force, was collected and the slope, defined as the compliance (in microS/N) of the system, was calculated. RESULTS: The highest compliance was found with hard splints. When splints were constructed on the upper molar, the highest compressive compliance was registered on the buccal side (2.8 microS/N) and tension compliance on the lingual side (-0.35 microS/N). When constructed on the lower tooth, the opposite was found. Soft splints resulted in compression on both the buccal and lingual sides when adjusted to the upper or lower tooth. A higher compliance was found on the buccal side (1.26 microS/N), while on the lingual side, the values varied (0.48-0.78 microS/N). CONCLUSIONS: Soft splints are more efficient in protecting teeth against the damage of bending forces although there is an increase of compression forces. The tooth opposing a hard splint is exposed to a higher risk of bending forces.

Analysis of Variance↗
PubMedDate not supplied

Optimal daily total end range time for contracture: resolution in hand splinting.

Reduced passive range of motion (PROM) of the joints of the hand is a common sequela of traumatic upper limb injury. Although mobilizing splinting is a common modality used by hand therapists to improve PROM, limited empirical evidence is available to guide therapist prescription. This study investigated the importance of the timing of splint application per 24-hour period, daily total end range time (TERT), via a prospective sequential clinical trial. A total of 43 subjects with joint contractures of the hand after traumatic upper limb injury were randomly allocated to one of two splint programs. Subjects in group A used their splint for less than 6 hours per day, and subjects in group B used their splint for 6 to 12 hours per day. Daily TERT was recorded by subjects in a splint diary. Passive torque range of motion (TROM) was used to measure the extent of contracture resolution over four weeks of splinting. High intrarater, interrater, and test-retest reliability of the TROM technique was established for this sample (intraclass correlation coefficients 0.993 to 0.998). Sequential analysis showed a statistically significant preference for group B, daily TERT of 6 to 12 hours per day (p < 0.05). Pretreatment joint stiffness (p = 0.162) and joint type (p = 0.463) did not influence final TROM significantly. These findings help to provide some controlled data from which therapists may base future prescription (dose) of daily TERT.

Adult↗
PubMedDate not supplied

Comparison of the biomedical motions and forces involved in high-profile versus low-profile dynamic splinting.

The purpose of this study was to compare the biomechanical motions and forces generated with a commercially available high-profile splint with those generated with a commercially available low-profile splint outrigger. The efficiency of the splints for maintaining index-digit supination during active flexion with the digit placed in slings generating a supination force couple was analyzed. The forces necessary to initiate and to maintain finger flexion were studied for each device using force transducers. Motion and force analyses were performed in the Biomechanics Evaluation Laboratory at Michigan State University. Synchronized video cameras recorded movement of anatomic landmarks, which were located by way of spherical retroreflective targets. Software programs calculated joint angles and digit movement. The results indicated that the high-profile splint held the digit in greater supination during flexion than did the low-profile splint. Also, the high-profile splint required less force during active flexion to initiate and to maintain motion than did the low-profile splint.

Biomechanical Phenomena↗
PubMedDate not supplied

Splints: mechanics versus convention.

Splints are specialized engineering machines that are created to solve specific upper-extremity problems. Astute manipulation of mechanical concepts increases splint efficiency, enhances patient comfort and function, and improves splint durability, while diminishing cost and frustration. Creation of splint designs should be based on mechanical fact rather than on mode-of-the-day bias. Those who are responsible for the treatment of upper-extremity dysfunction and use splinting as a treatment modality must have a thorough working understanding of the engineering concepts involved. Splinting is both science and art but the ultimate criterium is does it work mechanically? If a splint does not work mechanically, then there is no reason for its application. The insight provided by understanding engineering concepts opens new horizons in patient treatment for those who take the time to learn.

Biomechanical Phenomena↗
PubMedDate not supplied

A flexible dorsal wrist splint.

The authors have used a newly designed dorsal wrist splint on 65 patients since 1989. The splint base is made of Orthoplast. The design has a slender metacarpal bar across the palm, which does not interfere with the motion of the thumb and the normal sensation of the palm and provides some elasticity. The authors explored the conditions under which use of this splint would be appropriate from review of medical charts and the patients' comments. Fifty-five patients have used the splint, three patients could not use it, and another seven patients could not be reviewed about whether they used the splint. Of the 53 patients who could be interviewed in this study, 37 have worn the splint during housework and on the job. The authors believe that patients can perform most activities of daily living and occupations while using the dorsal wrist splint.

Adolescent↗
PubMedDate not supplied

Force analysis of the belly gutter and Capener splints.

In the management of hand injuries resulting from trauma or diseases like rheumatoid arthritis, hand therapists often design static and dynamic splints to rest and protect joints, provide stability, and enhance joint motion. However, the literature provides little help in analyzing the forces of a splint acting on a digit. This paper studies the forces generated by two different finger splints acting on the proximal interphalangeal joint (PIP) of the finger. The principles of force analysis are based on the Fess and Philips model of mechanics. Factors that affect the resultant forces generated by each splint design are identified, and the properties of each splint are discussed. Although the force generated by the two types of splints may vary only slightly, special features of each splint should be seriously taken into consideration in clinical application.

Contracture↗
PubMed1998

Effect of muscle relaxation splint therapy on the electromyographic activities of masseter and anterior temporalis muscles.

The purpose of this study was to compare the effectiveness of splint therapy on the electromyographic activity of masticatory muscles (anterior temporalis and masseter) before and after the application of a muscle relaxation splint. Electromyography recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in the intercuspal position both before and after treatment without a splint. Fourteen patients whose chief complaint was masticatory muscle pain were selected for the study. After the initial evaluations muscle relaxation splints were applied, and the patients were instructed to use the splints for 6 weeks. Surface electromyographic recordings were taken from each patient before the beginning of clinical therapy and after 6 weeks of wearing the splints. The data obtained were analyzed through paired sample t tests and Wilcoxon's signed rank tests. The results of the study were as follows: (1) the electromyographic activity of the two muscles during maximal biting was not markedly changed after the muscle relaxation splint was used; and (2) the changes observed in electromyographic activity of the involved and noninvolved sides were insignificant as well.

Adult↗
PubMed2002

Effect of stabilization-type splints on the asymmetry of masseter muscle sites during maximal clenching.

Patients with temporomandibular disorders may present with a cluster of joint and muscle disorders characterized primarily by pain, joint sounds and irregular or deviating jaw function. Maxillary stabilization-type splints represent the best standard therapy, so the purpose of this study was to evaluate changes in local maximal clenching-related asymmetry patterns of masseter muscle sites associated with the immediate 'application of splint therapy' using the diagnostic approach of high-resolution gray-scale ultrasonography. The study included 24 patients who had signs and symptoms of temporomandibular disorders. Ultrasonographic investigation was performed with a linear (B-scan) 7.5 Mhz small-part transducer to visualize the antero-superior, antero-inferior, medio-superior, medio-inferior, postero-superior, and postero-inferior sites of the masseter muscle. To assess local maximal clenching-related muscle asymmetry patterns and to evaluate the respective effect of occluding splints, the 'absolute asymmetry index' was used, with the mean maximum muscle diameter of the respective right and left sides calculated from three consecutive measurements before and after splint insertion. Comparing the values assessed before splint insertion with those after splint insertion revealed a significant decrease in local maximal clenching-related muscle asymmetry values for the antero-inferior masseter muscle site (P < 0.05). The results of this study suggest stabilization-type splints to have a site-specific effect in the immediate reduction of local maximal clenching-related muscle asymmetries. Further studies are warranted to evaluate muscle-site specific effects in patient and non-patient groups and to relate these effects to pre-treatment variables like bite force, preferred chewing side, facial morphology and occlusion.

Adult↗
PubMed2002

Effect of stabilization splint therapy on pain during chewing in patients suffering from myofascial pain.

Masticatory myofascial pain (MFP) condition is a musculoskeletal disorder that compromises the functional capacities of the masticatory system. As such, the incorporation of an intensive chewing test as a discriminatory exercise for the diagnosis of this condition and evaluation of treatment success has considerable potential. Various splint designs have been used successfully, which have posed a question of whether the therapeutic effect of the splint is a placebo or has some other curative properties. The purpose of this study was to evaluate the efficacy of the stabilization appliance to reduce signs and symptoms in MFP patients and to compare the pain experience during the chewing test between two groups of patients, with and without splints. Myofascial pain patients (n = 37) who reported exacerbation of pain in function participated in the study. Patients perfomed a 9-min chewing test, followed by 9-min rest and marked their pain intensity on a visual analogue scale every 3 min. Of the 37 patients, 21 received a stabilization flat occlusal splint for night use and 16 were equally monitored clinically without a splint. At the end of 8 weeks, a second clinical examination and chewing test were performed. Student's t-test was used to analyse differences between study groups. Analysis of variance and covariance (ancova) with repeated measures was applied to analyse the effect of treatment. Level of pain at baseline prior to the chewing test (P0) was introduced as a co-variant. At baseline both groups showed relatively high scores of pain intensity and did not show any significant differences among the collected variables. At the end of the experiment, the splint group had a statistically significant reduction in pain intensity, in mean muscle sensitivity to palpation and in the pain experience during the chewing test compared with no change in the controls. A stabilization splint has a therapeutic value beyond its placebo effects. Thus, it should be an integral part of the treatment modalities in MFP disorder patients. An intensive chewing test is an effective tool to evaluate the treatment modality efficacy in MFP patients.

Adult↗
PubMed1999

Splinting in the treatment of arthritis of the first carpometacarpal joint.

Although much has been written about surgical treatment of arthritis of the first carpometacarpal joint, no literature exists on splinting as a conservative treatment. One hundred fourteen patients (130 thumbs) were retrospectively reviewed to determine the efficacy of splinting. Patients were grouped according to their stage of disease and whether they had carpometacarpal joint surgery. Seventy-six percent of patients with stage I and II disease and 54% of patients with stage III and IV disease had improvement in their symptoms with splinting. There was no significant difference in the degree of improvement between the 2 groups. All patients who had initial improvement in their symptoms with splinting had between 54% and 61% average improvement in symptom severity 6 months after splinting. All groups were found to be equally tolerant of the splinting protocol and no group had a significantly higher rate of activity modification. Overall, splinting was found to be a well-tolerated and effective conservative treatment to diminish, but not completely eliminate, the symptoms of carpometacarpal joint arthritis and inflammation.

Activities of Daily Living↗
PubMed2002

Dynamic splinting of forearm rotational contracture after distal radius fracture.

The results of dynamic forearm rotational splinting for the treatment of forearm rotational contractures in patients with acceptably aligned, healed distal radius fractures are documented. Fifteen patients with distal radius fractures that healed with < or =+5 mm ulnar variance and < or =20 degrees dorsal tilt had dynamic forearm rotational splinting for contractures that had failed conventional hand therapy. Average pronosupination arc before splinting was 83 degrees. Dynamic forearm rotational splinting increased forearm rotation by 52% to an average of 126 degrees. Only one patient with development of ectopic bone in the interosseous space during splinting failed to obtain at least 30 degrees pronation and supination after splinting. Dynamic forearm rotational splinting effectively treats rotational contractures in patients who have healed distal radius fractures that are in acceptable alignment.

Adult↗
PubMed1993

The effect of the stabilization splint on the TMJ closed lock.

The mandibular manipulation technique and anterior repositioning splint are considered acceptable conservative therapies for an acute temporomandibular joint (TMJ) closed lock. However, an anterior repositioning splint will result in a corresponding change in occlusion, such as posterior open-bite. Furthermore, invasive treatments such as surgery have many complications. This article describes the effect of the stabilization splint with more conservative therapies, including the manipulation technique, wherein the complications are minimal. In this study, the authors used the stabilization splint instead of the anterior repositioning splint. They obtained acceptable results, including the increase of interincisal distance, a decrease in Fricton's craniomandibular index, and a decrease in Helkimo's clinical dysfunction index. Therefore, the treatment method that is composed of a stabilization splint, manipulation, moist heat, and exercise should be considered as the first choice of treatment for TMJ closed lock, as opposed to a repositioning splint.

Adolescent↗
PubMed1996

An elastic plastic splint to compress the ear after reconstruction using a temporoparietal fascial flap.

We designed a new splint that is used to compress the ear after reconstruction using the temporoparietal fascial flap method to reduce postoperative swelling rapidly. The splint, which is made of an elastic plastic material, was applied to 3 patients with an acquired ear defect. The application period using this splint was from 10 days after surgery up to 3 to 6 months. Swelling of the reconstructed ear subsided rapidly after application of the splint. The contour was then enhanced in all patients. We were able to apply compression to the region as required, using a sponge attached to the splint. The splint is soft enough to remain in place, even if the patient continues regular activities. We conclude that the elastic plastic splint is useful to compress the ear after reconstruction using the temporoparietal fascial flap method.

Ear Deformities, Acquired↗
PubMed2007

Lower eyelid splinting: An alternative to the Frost suture.

OBJECTIVES: To describe a new method of postoperative eyelid suspension used for the prevention of eyelid malposition and to report its efficacy through an outcome study. STUDY DESIGN: An outcome study was performed on 10 patients who would potentially need postoperative eyelid suspension. Candidates included patients with entropion, ectropion, or orbital fractures requiring transconjunctival approaches. Patients were photographed pre- and postoperatively and followed for signs of eyelid malposition. METHODS: At the conclusion of the surgical procedure, a sheet of Xeroform gauze was folded into 6 overlapping layers and cut to conform to the shape of the inferior orbital rim. The superior edge of the gauze was sutured to the lower eyelid using interrupted 5-0 nylon suture. Sutures were placed at the medial and lateral canthi to raise the eyelid above the inferior limbus and along the inferior orbital rim. The splint was removed between postoperative days 7 and 14. RESULTS: There were no perioperative complications related to the surgery or placement of the splint. No cutaneous marks persisted after healing. No complications such as shifting of the splint, ocular damage, or recurrent eyelid malposition occurred. One patient had asymptomatic restriction of lower eyelid elevation on upward gaze, which resolved at 6 months. CONCLUSIONS: The lower eyelid splint appears effective in maintaining lower eyelid position postoperatively. There were no complications with its use, and the splint was tolerated well. Benefits of the splint over the Frost suture include less risk of corneal abrasion, ability to check visual function, and ability to use the splint bilaterally.

Adult↗
PubMed1992

The use of intra-nasal splints: a consultant survey.

A questionnaire was sent to all United Kingdom consultants enquiring about their use of intra-nasal splints. 301 (70%) consultants replied. The commonest reason given for use of nasal splints was to try to prevent the formation of adhesions. Flat, pre-shaped silicone rubber splints were by far the most frequently used type. 64% used splints routinely for operations involving both walls of the nasal cavity. Just over one-third of respondents never or 'rarely' (less than 1 in 50 cases) used splints for procedures involving both walls of the nasal cavity. They reported an adhesion rate of 5.2% which was only 1.3% greater than that reported by those who always or 'sometimes' (at least 1 in 10 cases) used splints. Comments from some respondents and review of the literature suggests that early out-patient review with the use of nasal toilet is an effective alternative to using nasal splints in the prevention of intranasal adhesions.

Consultants↗
PubMed1979

The effect of splinting on tooth mobility. (2) After osseous surgery.

The purpose of this study was to determine if fixed splinting of teeth with intraoral wire and acrylic splints had advantages with respect to tooth mobility, bone level and attachment level over unsplinted teeth following osseous surgery. Ten patients were chosen who exhibited bilaterally similar chronic destructive periodontitis and mobile teeth. One maxillary sextant was splinted, while the other was unsplinted. Both sextants functioned against an unsplinted mandibular arch. Following initial therapy, osseous surgery was performed in both maxillary sextants on the same day. Tooth mobility data was collected 1 week before and at 3, 6, 12, and 24 weeks following surgery. Levels of gingival attachment and bone were recorded before and 24 weeks after surgery. Splints were removed before measurements, then replaced, and the occlusion refined. Prophylaxes and oral hygiene instruction were repeated every 3 weeks throughout the study. For all categories of teeth and mobility examined, tooth mobility increased initially after surgery and subsequently decreased by 24 weeks to about presurgical values. The splinted and unsplinted segments reacted similarly throughout the study; splinting did not significantly reduce the mobility of individual teeth. Pre- and postsurgical bone and gingival attachment levels were also similar for the splinted and unsplinted segments.

Adult↗
PubMed1979

The effect of splinting on tooth mobility. I. During initial therapy.

The purpose of this study was to assess whether fixed splinting aided in the reduction of posterior tooth mobility during initial therapy. A "split-mouth" approach was used in order to compare splinted segments with similar unsplinted segments. Seven patients were selected, all of whom demonstrated chronic destructive periodontitis and mobile teeth. Initial therapy, consisting of oral hygiene instruction, root curettage and occlusal adjustment, was performed over a 2-week period. At the time of initial therapy, teeth in contralateral segments were splinted with an intracoronal wire-and-acrylic splint. Tooth mobility and gingival inflammation were recorded in all four segments every 3 weeks for a 15-week monitoring period following initial therapy. The splints were removed before each data recording session and then replaced and the occlusion refined. Prophylaxis and oral hygiene instruction were repeated every second week throughout the monitoring period. The reduction in the mobility of teeth splinted during the entire therapy period did not differ from the reduction observed in the unsplinted segments. The reduction in tooth mobility observed in both the splinted and unsplinted segments over the 17-week period can be attributed to the improved occlusal relationships and reduction in inflammation.

Adult↗
PubMed2006

The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial.

AIM: To assess whether the use of a night splint is of added benefit on functional outcome in treating chronic midportion Achilles tendinopathy. METHODS: This was a single-blind, prospective, single centre, randomised controlled trial set in the Sports Medical Department, The Hague Medical Centre, The Netherlands. Inclusion criteria were: age 18-70 years, active participation in sports, and tendon pain localised at 2-7 cm from distal insertion. Exclusion criteria were: insertional disorders, partial or complete ruptures, or systemic illness. 70 tendons were included and randomised into one of two treatment groups: eccentric exercises with a night splint (night splint group, n = 36) or eccentric exercises only (eccentric group, n = 34). INTERVENTIONS: Both groups completed a 12-week heavy-load eccentric training programme. One group received a night splint in addition to eccentric exercises. At baseline and follow-up at 12 weeks, patient satisfaction, Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) score and reported compliance were recorded by a single-blind trained researcher who was blinded to the treatment. RESULTS: After 12 weeks, patient satisfaction in the eccentric group was 63% compared with 48% in the night splint group. The VISA-A score significantly improved in both groups; in the eccentric group from 50.1 to 68.8 (p = 0.001) and in the night splint group from 49.4 to 67.0 (p<0.001). There was no significant difference between the two groups in VISA-A score (p = 0.815) and patient satisfaction (p = 0.261). CONCLUSION: A night splint is not beneficial in addition to eccentric exercises in the treatment of chronic midportion Achilles tendinopathy.

Achilles Tendon↗