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PubMed2005

[Influence of sleep bruxism on dislodgement of dental restorations].

PURPOSE: This study investigated the correlation between strength of sleep bruxism and dislodgement of dental restorations, by both using the facet index of occlusal splint for sleep bruxism and measuring the dislodgement rate of dental restorations. METHODS: Subjects consisted of 422 patients with 3673 dental restorations (inlay, crown, jointed crowns, and bridge) referred to the hospital from 1976 to 2004 who were randomly selected from 912 patients. All patients wore an occlusal splint during sleep. Ink was placed on the occlusal part of the splint and the strength of sleep bruxism was evaluated by the wearing away of the ink and indentation on the splint (Ikeda's method). The subjects were classified into the following four groups according to the evaluation: B-0: no facet on the splint, B-1: slight facet with wearing of the ink but no indentation on the splint, B-2: slight indentation on the splint, and B-3: notable indentation on the splint, and then the dislodgement rate between the groups was compared. The mean evaluation time in each patient was 10.1 years. RESULTS: The rate of patients with dislodgement was B-1: 12.7%, B-2: 35.1%, and B-3: 43.8%. The dislodgement rates of categorized restorations in groups B-1, B-2, and B-3 15 years after the placement were, restorations: 9%, 18%, and 24%, inlay: 19%, 24%, and 32%, and crown: 5%, 12%, and 13%, respectively. CONCLUSIONS: It is proved that the evaluation method using the facet index of occlusal splint for sleep bruxism is a reliable means of estimating how long the restoration will last. The results showed that sleep bruxism influences the dislodgement of restorations. To protect restorations, it might be effective to control the load from sleep bruxism.

Dental Restoration Failure↗
PubMed2003

Navigated transoral approach to the cranial base and the craniocervical junction: technical note.

OBJECTIVE: The transoral approach is an elegant reliable surgical procedure that provides anterior exposure of the cranial base and the craniocervical junction. Our objective was to demonstrate the advantages of neuronavigation in planning and performing the transoral approach. METHODS: Three patients with chordomas and one patient with rheumatoid atlantoaxial subluxation were considered for a neuronavigated transoral procedure. For image guidance, the Stryker navigation system (Stryker Instruments, Kalamazoo, MI) was used. Registration was performed with individually constructed occlusal splints with four markers. RESULTS: The transoral approach was successfully used for two patients with chordomas involving the cranial base and the upper spine and for one patient with dislocation of the dens and medullary compression. In one case, preoperative simulation of the approach and trajectory planning demonstrated that adequate resection could not be achieved via the transoral route, and a paracondylar suboccipital approach was used. The registration accuracy achieved with the occlusal splint was less than 1 mm. CONCLUSION: Neuronavigation is a useful tool for planning and performing a transoral approach. It optimizes preoperative planning, clarifies and secures resection limits, and reduces overall surgical morbidity. Registration with an occlusal splint with four markers proved to be an attractive alternative to conventional systems.

Adult↗
PubMed2005

Flexure deformation in temporomandibular joint disk displacement without reduction may predict treatment outcome.

To identify whether the direction of disk flexure deformation predicts the prognosis in cases of anterior disk displacement without reduction of painful temporomandibular joint (TMJ), the relationship between the direction of flexure, observed on pseudodynamic magnetic resonance (MR) images, and the outcome of conservative treatment using a flat occlusal splint was analysed in 40 female patients who perceived occasional or constant pain at unilateral TMJ with disk displacement without reduction. From the MR findings, 20 patients were classified as having upward flexure deformation of the disk and 20 as having downward flexure deformation. Patients' TMJ pain, masticatory muscle pain, amount of maximal mouth opening, and MR findings were evaluated before treatment. All patients were treated with a flat occlusal splint for 6 months. The patients' signs and symptoms were analysed statistically within each group before treatment and 3 and 6 months afterwards, and were also compared between the upward and downward flexure groups. There was no statistical difference between the groups before treatment, except in the amount of maximal mouth opening and the extent of disk displacement. The upward flexure group had persistent TMJ pain and tendency of delayed alleviation of masticatory muscle pain compared with the downward flexure group, although maximal opening gradually increased in both groups. Thus, the direction of the flexure in deformation of the disk, which can be observed only with pseudodynamic MR imaging, may predict the prognosis of painful disk displacement without reduction following treatment with a flat occlusal splint.

Adolescent↗
PubMed2005

Polymerization characteristics of light- and auto-curing resins for individual splints.

OBJECTIVES: The aim of this in vitro study was to assess different resins for occlusal splints regarding a number of polymerization characteristics. METHODS: One autopolymerizing resin (Palapress) and four light-curing resins (Acrylight, Primosplint, Triad TranSheet Colorless and Pink) were tested for flexural strength, modulus of elasticity, water sorption, volumetric shrinkage, and conversion of double bonds. These resins were polymerized for 10 and 15 min in a light oven at frequencies between 320 and 400 nm or 400 and 500 nm, respectively. Data were treated statistically by ANOVA and by Scheffé test. RESULTS: Concerning flexural strength and modulus of elasticity, Triad TranSheet Colorless showed significantly greater values than Primosplint and Palapress (p<0.05). The light curing resins Acrylight and Primosplint featured significantly higher water sorption when cured for 10 min compared to all other resins (p<0.05). Acrylight displayed significantly higher volumetric shrinkage and a higher quantity of remaining double bonds compared to all other light-curing resins (p<0.05). Primosplint, Triad TranSheet Colorless and Pink showed significantly lower shrinkage values than autopolymerizing Palapress (p<0.05). For all light curing resins, polishing of the samples resulted in a significantly lower quantity of remaining double bonds (p<0.05) compared to unpolished samples. SIGNIFICANCE: With respect to the polymerization properties evaluated, the light-curing resins reached similar material properties to the autopolymerizing resin or even surpassed them. Light-curing resins seem to be suitable for the fabrication of occlusal splints and can been seen as an alternative to autopolymerizing polymethylmethacrylates.

Acrylic Resins↗
PubMed2006

Occlusion, sternocleidomastoid muscle activity, and body sway: a pilot study in male astronauts.

The modifications induced by microgravity on the coordinated patterns of movement of the head, trunk, and limbs are reported on extensively. However, apparently there is little data on the masticatory muscles. In normal gravitational conditions, information from the neck and stomatognathic apparatus play a role in maintaining the body's balance and equilibrium. The current pilot study used normal gravity conditions to investigate the hypothesis of a functional coupling between occlusion and neck muscles and body postural oscillations. The immediate effect of modified occlusal surfaces on the contraction pattern of the sternocleidomastoid muscles during maximum voluntary clenching and on the oscillation of the center of foot pressure was analyzed in 11 male astronauts (aged 31-54 yrs). All subjects were healthy and free from pathologies of the neck and stomatognathic apparatus. Occlusal splints were prepared using impressions of their dental arches. The splints were modeled on the mandibular arch, had only posterior contacts, and were modified to obtain a more symmetric, standardized contraction of the masseter and temporalis muscles during teeth clenching. Surface EMG activity of the sternocleidomastoid muscles was recorded during a maximal voluntary clench with and without the splint. Sternocleidomastoid potentials were standardized as percent of the mean potentials recorded during a maximum contralateral rotation of the head, and the symmetry of the EMG waves of left- and right-side muscles was measured. Body sway was assessed with and without the splint, either with eyes open or closed. The variations of the center of foot pressure were analyzed through bivariate analysis, and the area of the 90% standard ellipse was computed. Within each visual condition (eyes open or closed), the difference between the areas of oscillation measured with and without the splint was computed. Muscular activity was more symmetric with the splint. The area of oscillation of the center of foot pressure was larger without the splint than with the splint, both with eyes open and eyes closed. The modifications, induced by the occlusal splint in the sternocleidomastoid muscles' symmetry, and center of foot pressure differential area with closed eyes, were significantly related (p < 0.05): the larger the increment in muscular symmetry, the smaller the area of oscillation with the splint as compared to without the splint. A functionally more symmetric maxillo-mandibular position resulted in a more symmetric sternocleidomastoid muscle contraction pattern and less body sway. Modifications in the contraction of the masticatory muscles may therefore affect the whole body.

Adult↗
PubMed1996

Orthotics and orthodontics.

Many doctors think of orthotics or occlusal splints in connection with temporomandibular joint dysfunction patients and treatments. Few think of occlusal splints or intraoral orthotics in conjunction with orthodontics as diagnostic instruments. This article will demonstrate a close association between intraoral orthotics for diagnostic purposes to establish a functional mandibular-maxillary relationship before or during orthodontic treatment. Orthotics allow the practitioner to establish and maintain a harmony between the joint structures, the muscles and the dentition. Orthotics establish the stable orthopedic relationship prior to orthodontic intervention and thus, the end point of treatment established prior to irreversible corrections and a diagnosis of cause-effect relationships can be determined. Properly relating the mandible to the maxilla allows the opportunity to determine the arch developmental requirements necessary to maintain this functional relationship.

Humans↗
PubMed1995

Occlusion and prosthodontics.

Occlusion in prosthodontics is extremely important. Muscle dysfunction can interfere with prosthodontic restoration of occlusion. Occlusal interferences are the primary cause of the hyperactivity that cause muscle dysfunction. Occlusal interference can also place adverse stress on restorations and result in premature failures. Lateral stresses on restorations can cause cement failures, porcelain fractures, and solder joint failures. Our goal in prosthodontics is to restore occlusion that is occlusal interference free. This article gave an overview of how this can be done in phases. In Phase I, a diagnosis is made as to the presence or absence of muscle dysfunction. If it is present, the OIs are hidden. Occlusal splint therapy is needed to get rid of the muscle dysfunction so the OIs can be found. The occlusal splint diagnosis whether OIs are the cause of the dysfunction. The cure is to correct the occlusion. The restoration of the occlusion should be OI free. The various factors to consider in design and restoration of the occlusion were presented. After successful restoration of the occlusion, the recall appointments should include an evaluation of the occlusion. The PRI, COS, and clinical examination can all be helpful in diagnosing whether muscle dysfunction is developing and whether OIs are developing again as a result of the normal changes that can occur. Suggestions were made on how to slow these changes. This article was not meant to cover every aspect of prosthodontic occlusion in detail. The goal was to present an overview for readers to make a self-evaluation as to what areas of their practice might need to be improved to improve the restoration of the occlusion. All was not taught in dental school. As one practices and improves in skill, more knowledge and abilities must be sought through graduate and postgraduate education. Occlusion is too important for a successful practice and happy patients to be ignored. Time will make this obvious; however, the failures may be costly. The best approach would be to anticipate the failures and prepare yourself to reduce the risks. Occlusal interferences are truly the plague of dentistry.

Bite Force↗
PubMed2000

Influence of protrusive tooth contact on tapping point distribution.

This study investigated the influence of protrusive tooth contacts (tooth contacts during mandibular protrusion) on the tapping point distribution. Nine healthy subjects volunteered for this study and the protrusive tooth contact pattern, as well as the retrusive tooth contact pattern, was altered on four maxillary occlusal splints. The first splint was adjusted to make the sagittal incisal path of protrusion and retrusion equivalent to that of the natural dentition. The second and third splints had partial and complete elimination of the protrusive tooth contact, respectively. The fourth splint had complete elimination of both protrusive and retrusive tooth contacts. The subjects were asked to use each splint continuously for 1 week. The tapping point distribution was measured on the 7th day after insertion of each splint. The four experimental occlusal conditions were found to have a significant effect on the tapping point distribution. The complete elimination of the protrusive tooth contact caused an anterior tapping point location and an increase in the tapping point area. The former tendency was found to be independent of the presence of the retrusive tooth contact. In conclusion, it was suggested that the protrusive tooth contact plays a significant role in maintaining the consistency and stability of the tapping point.

Adult↗
PubMed2003

Accuracy of adaptation of thermoformed poly(methyl methacrylate).

Thermoformed poly(methyl methacrylate) (PMMA) sheet is used to produce a number of different dental appliances such as stents, occlusal splints and baseplates for occlusal rims. The purpose of the present study was to measure the accuracy of adaptation of Perspex PMMA sheet and to determine the effect of annealing on the accuracy of the thermoformed specimens. The results of the study showed that PMMA can produce specimens that are accurately adapted to the cast. Immersion in water resulted in an increase in the space between the cast and the specimen for both thermoformed and thermoformed and annealed acrylic resin. Annealing of the thermoformed specimens had significantly less increase in space between the cast and the specimens when immersed in water over a period of 3 months.

Acrylic Resins↗
PubMed2003

Iatrogenic pain dysfunction syndrome of the masticatory system--case study.

A female patient, age 71, came to The Department of Prosthetic Dentistry University School of Medicine in Lublin with pain dysfunction syndrome after treatment by extensive prosthesis of upper and lower dental arches. After examination many abnormalities of prosthetic restorations were ascertained. After 21 months of repositioning occlusal splint treatment the symptoms of pain dysfunction were gone, which permitted final prosthetic restoration. This case proves that using repositioning occlusal splint should be the first choice procedure in the treatment of iatrogenic pain after prosthetic treatment.

Aged↗
PubMed1991

Acupuncture in treatment of facial muscular pain.

Forty-five individuals with long-standing facial pain or headache of muscular origin were randomly allocated into three groups. The first group was treated with acupuncture, the second group received an occlusal splint, and the third group served as controls. Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system. No differences between these two groups were found with regard to treatment effects. It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniomandibular disorders of muscular origin.

Acupuncture Analgesia↗
PubMed2004

[Efficacy of treatment with hard and soft occlusal appliance in TMD].

Temporomandibular disorders (TMD) include clinical disorders involving the masticatory muscles, the temporomandibular joints (TMJ) and the adjacent structures. TMD was recognized as a main source for pains in the orofacial area, which are not caused from dental origin, and is defined by the American Academy of Orofascial Pain (AAOP) as a sub-group within the frame of musculoskeletal disorders. The main etiology for TMD has not been found yet. The customary treatments for this disorder include treatment with occlusal splints, physiotherapy, medicaments, behavioral-cognitive treatment, hypnosis, acupuncture and surgery that should be considered only if all conservative treatments were unsuccessful. Occlusal splint is the most common and efficient treatment for TMD patients proved by many studies with a successful rate of 70-90%. The following article reviews the different opinions in the treatment of TMD with special attention to hard and soft occlusal appliances. Based upon much research, and despite the many disagreements regarding its efficacy, the hard splint is a customary application which has the most successful outcome in patients who suffer from functional disorders of the masticatory system. The stabilization splint has an important benefit for being a non-penetrating and reversible appliance. However, despite this, the dentist should evaluate the joint or muscular problem, and seriously consider the various available treatments before deciding to use the appliance as a means of treatment.

Centric Relation↗
PubMed2002

[Influence of the relaxation splint and stabilization splint on the EMG parameters of the masticatory muscles].

OBJECTIVE: To explore the influence of the type of occlusal splint on the masticatory muscles (TA,MM). METHODS: TA and MM EMG during ICP maximal clenching were recorded in 20 dentate normal subjects, when they weared no occlusal splint, relaxation splint and mandibular stabilization splint. RESULT: With the insertion of relaxation splint and mandibular stabilization splint, the EMG parameters of TA and MM during ICP maximal clenching was dramatically reduced (P<0.05). CONCLUSION: The relaxation splint and mandibular stabilization splint can relax the masticatory muscles.

English Abstract↗
PubMed2004

Effects of a functional appliance on masticatory muscles of young adults suffering from muscle-related temporomandibular disorders.

The aim of this study was to investigate the effects of an original orthodontic functional appliance [function generating bite for deep bite correction (FGB-D)] on masticatory muscle activity in subjects suffering from muscle-related temporomandibular disorders (TMD). Electromyographic (EMG) analysis was performed on 33 young adults (nine men, 24 women) to evaluate the contractile symmetry of the right and left masseter and anterior temporalis muscles. The subjects were divided into three groups: a muscle-related TMD group requiring orthodontic treatment for deep bite correction (three men, eight women) and treated with FGB-D; a muscle-related TMD group not requiring orthodontic treatment (three men, eight women) and treated with a Michigan occlusal splint; and a TMD-free group (three men, eight women) as a control group. Records were made by surface EMG of maximum voluntary teeth clenching, with and without the functional appliance or occlusal splint in place, before and after 12 months of therapy. A torque index was derived from the surface EMG recordings to estimate lateral displacement of the mandible. The results show that the FGB-D corrects the torque index and thus the lateral displacement of the mandible.

Adult↗
PubMed1978

Effects of occlusal therapy on pantographic reproducibility of mandibular border movements.

A clinical experiment was undertaken to study the relationship between occlusal therapy and pantographic reproducibility. Twenty-six subjects were categorized according to their ability to reproduce pantographic border movements and were put into either a control nonreproducible, control reproducible, or experimental nonreproducible group. From each subject a sequence of five pantographic surveys consisting of two morning and two afternoon pantographic recordings was taken. Each survey period lasted a minimum of 30 days. The experimental subjects alone were given occlusal splint therapy and occlusal adjustment therapy during the sequence of recall periods. The relationship between the effect caused by occlusal therapy and pantographic reproducibility was analyzed. For the purpose of analysis, the pantographic recordings were assessed a numerical score using a pantographic reproducibility index. A double-blind technique was used until all data were collected.

Adult↗