Stomatognathic Protective Orthotic: a new dental splint utilized with an objective diagnosis and outcome monitoring technique.
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Biofeedback, Psychology↗
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Survival of ceramic onlays placed with and without metal reinforcement.
STATEMENT OF PROBLEM: All-ceramic molar onlays continue to have higher failures from bulk fracture than similar cast metal onlays. PURPOSE: The purpose of this retrospective study was to compare long-term failure rates and causes for posterior sintered feldspathic ceramic (Mirage) onlays placed with and without metal substructure reinforcement. MATERIAL AND METHODS: Nineteen onlays were placed with and 78 without metal reinforcement in 50 older adolescent and adult patients treated by 2 prosthodontists in a private practice. All onlays opposed occluding tooth surfaces. Clinical judgment determined the type of onlay placed. Observational factors included patients, clinicians, onlay sites, and failure modes. Acrylic resin maxillary splints were generally provided for patients with multiple onlays or parafunctional habits. Thirty-six dies were also available for comparison of the occlusal thickness and taper of intact and failed molar onlays. The chi-square test or Fisher exact test, Student t test, and life table survival statistics were used to evaluate the data (alpha=.05). RESULTS: Over 6 years, failures occurred in 21.1% of onlays placed with metal reinforcement and in 26.9% without metal reinforcement. Cumulative survival estimates (+/- standard error) were 62.4% +/- 14.7% and 60.5% +/- 6.3%, respectively (P=.84). Bulk fracture occurred in 16.5% of molars, independent of metal reinforcement (P=1.00). Overall, 11.4% of premolar and 33.9% of molar onlays failed. Irreversible pulpitis occurred in 6.2% of all teeth. From the dies, there were no clear relationships between either the thickness of occlusal ceramic material or the internal preparation taper and molar onlay failures, for onlays placed with or without metal reinforcement. CONCLUSION: Sintered ceramic onlays placed with and without metal reinforcement showed a similar incidence of bulk fracture in molars. Preparations for both types of onlays were similar.
Adolescent↗
Does 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?
The aim of this pilot study was to investigate the effects of 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range, 46.5 to 79.8 years), referred from the Ear, Nose, and Throat Department, were treated with an acrylic splint with full tooth coverage that advanced the mandible 5 to 8 mm (70% of maximal protrusion) and used 5 mm opening vertically. The splint was used 6 to 8 hours per night and 5 to 7 nights per week. Two lateral head radiographs were taken in centric occlusion, 1 before and 1 after 2 years of treatment. A small but statistically significant forward and downward change in mandibular position was found after treatment; mean was 0.4 mm (SD, 0.53; range, 0.0 to 2.0 mm; P <.001) and 0.3 mm (SD, 0.43; range, 0. 0 to 1.5 mm; P <.001), respectively. The forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length-mean was 0.4 mm (SD, 0.62; range, 0.0 to 2.5 mm; P <.01)-and a significant decrease in overjet (P <.001) and overbite (P <.05). However, none of the patients reported any permanent sense of altered occlusion, and the anteroposterior distance between habitual occlusion (intercuspal position) and centric relation (retruded position) did not exceed 1. 0 mm in any of the patients either before or after the treatment. The change in mandibular position might be a result of a condylar and/or glenoid fossa remodeling or condylar position changes within the fossa as a compensatory reaction to the advancement of the mandible (bite jumping). However, to visualize and analyze such possible changes in detail, additional studies using lateral tomography of the temporomandibular joints or magnetic resonance imaging are required. Furthermore, because the treatment of snoring and OSAS patients is considered to be lifelong, long-term studies are needed to analyze if the small change in mandibular position will continue with further treatment.
Adaptation, Physiological↗
Experiences from a facial pain unit.
During the academic year 1988/1989, 282 patients with chronic orofacial pain were referred to the facial pain unit of the University of Helsinki; 143 of these patients were suffering mainly of orofacial dysesthesia and 139 patients of masticatory dysfunction. Thirty-six of the patients with orofacial dysesthesia were referred for a psychiatric consultation. The result revealed a strong mental disturbance component associated with this kind of pain disorder. The patients with orofacial dysesthesia were treated mostly with amitriptyline, clonazepam, and distigmin; the patients with masticatory dysfunction were treated with splints and/or occlusal rehabilitation.
Adult↗
Principles of stabilization bite splint therapy.
The stabilization bite splint is discussed with regard to design, delivery, and clinical procedures that contribute to conservative appliance therapy. Indications for stabilization bite splint therapy and a clinical case report are presented.
Adult↗
The pattern of splint usage in the management of two common temporomandibular disorders. Part II: The stabilisation splint in the treatment of pain dysfunction syndrome.
OBJECTIVE: To examine whether the stabilisation splint is a suitable treatment for pain dysfunction syndrome and to determine the most appropriate pattern of usage. DESIGN: Prospective random control clinical trial. SETTING: Dental school clinic unit. SUBJECTS: 70 patients diagnosed with pain dysfunction syndrome were treated with a stabilisation splint for 3 months. Group 1 (23 patients) wore the splint 24 hours/day. Group 2 (19 patients) wore the splint only during the day. Group 3 (28 patients) wore the splint only at night. RESULTS: There was no statistically significant advantage to any pattern of splint usage; all groups showed a marked improvement by subjective and objective assessment. CONCLUSIONS: Patients being treated for pain dysfunction syndrome by a stabilisation splint need wear the splint only at night.
Adolescent↗
The immediate effect of hard and soft splints on the EMG activity of the masseter and temporalis muscles.
The aim of this study was to compare the effects of hard and soft splints on the activity of the anterior temporalis and masseter muscles. Surface EMG recordings were made from these muscles during clenching at 10% of maximum, 50% of maximum and at maximum clench, both before and after insertion of a hard splint. This sequence was then repeated with a soft splint. The relative level of activity in the anterior temporalis and masseter muscles at all three activity levels was quantified by means of an Activity Index, which provides a measure of the balance of activity in the masseter relative to the activity in the anterior temporalis muscle. It was found that hard splints led to a decrease in EMG activity in relation to activity with no splint in both muscles at maximum clench and particularly the anterior temporalis. Soft splints produced a slight increase in activity of both muscles, but particularly the masseter muscle. The Activity Index indicated a shift in the balance of activity away from the anterior temporalis muscles with both splints, particularly at 10% of the maximum clenching level. It is possible that the decrease in activity of the temporalis muscles relative to the masseter muscles may be a factor in the therapeutic effect of both a hard and a soft splint, although the decrease is clearly greater with the hard splint.
Acrylic Resins↗
Use and effectiveness of splint appliance therapy: review of literature.
Interocclusal orthopedic appliances of varied design and application have been employed in the treatment of myofascial pain dysfunction (MPD) and temporomandibular joint disorders (TMD). These appliances provide the practitioner with a non-invasive, reversible form of intervention to manage the patient's symptoms. Literature on the use and effectiveness of these appliances has become readily available and now requires retrospective evaluation. However, comparison of results from studies making use of interocclusal orthopedic appliance therapy is difficult due to the employment of various outcome measurement scales, subjective evaluation of patient outcome, and variability in reporting of treatment outcomes. The aim of this paper is to review the effects and success rates of the various appliances reported in the literature and provide the practitioner with useful information that may be of assistance in the prediction of outcome and success of splint appliance therapy.
Electromyography↗
Patient preference for light-cured composite bite splint compared to heat-cured acrylic bite splint.
BACKGROUND: Heat-cured acrylic has been the most commonly used material for construction of bite splints. Although effective, its processing involves several steps and is time consuming. Furthermore, acrylic splints distort easily if not kept in water when not worn for long periods of time. A newly developed light-cured composite material is now being used for bite splint fabrication. The composite material offers benefits in ease and speed of construction, has minimal warping and distortion, and has proven patient acceptance. The aim of this study was to determine if patient satisfaction with the composite splint was as good as, or preferential to, the acrylic splint. METHODS: Both a composite and an acrylic bite splint were fabricated for each of 10 patients. The splints were worn alternately on a nightly basis and were adjusted as needed after the first week. After 3 weeks, each patient completed a questionnaire regarding the properties of each splint and any preferences they had in reference to fit, comfort, and other parameters of satisfaction. RESULTS: All of the patients were able to wear at least one of the splints comfortably. All 10 preferred the composite splint over the acrylic splint, agreeing that it felt more natural and was more comfortable to wear. CONCLUSIONS: The light-cured composite bite splint is preferable from the patient's perspective to the heat-cured acrylic bite splint. The composite splint is rapidly constructed on the original model, easily seated, and comfortably worn. Other properties of composite material also make it preferable for long-term use. Future studies are necessary to evaluate the functional differences between the composite and acrylic splint.
Acrylic Resins↗
Rehabilitation of occlusal support by removable partial dentures with free-end saddles.
This study aimed to assess the level of restored occlusal support by removable partial dentures with free-end saddles. The maximal clenching force of 61 subjects was measured using pressure sensitive film with and without their dentures. The restored level of occlusal support was estimated from the shift of the occlusal load centre. In comparison with previous results of experimental occlusions using splints for eight normal dentate subjects, the restored level using dentures ranged from 40-60% of that of natural teeth. The analysis of the shift of the occlusal load centre could reasonably evaluate the prostheses from the standpoint of occlusal support.
Adult↗
Bite plates and stabilization splints in mandibular dysfunction. A clinical and electromyographic comparison.
Twenty patients with mandibular dysfunction, all women, aged 17-41 years, were randomized for treatment with either a bite plate with a frontal plateau or a full-coverage stabilization splint. The occlusal appliances were used at night for 6 weeks to compare clinical and electromyographic effects (EMGs). Integrated EMGs were recorded bilaterally from the anterior and posterior parts of the temporal muscle and the masseter muscle in the rest position and during gentle and maximal biting before and after treatment without the appliances in situ. Initially recorded EMG activity in the temporal muscle was correlated to signs of dysfunction in the rest position. Compared with previously investigated healthy subjects, the patients had lower EMG activity in the anterior part of the temporal muscle and in the masseter muscle during maximal biting. Use of occlusal appliances at night for 6 weeks did not change the EMG activity in the rest position or during maximal biting. The clinical signs improved, significantly in the splint group. The subjective symptoms improved in both groups, significantly more in the splint group.
Adolescent↗
Successful treatment of self-inflicted oral mutilation using an acrylic splint retained by a head gear.
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Child, Preschool↗
[A method for splinting the teeth in the absence of an adequate number of abutment teeth].
Angle's device with orthodontic crowns for the [formula: see text] teeth was used as a splinting device in a patient aged 11 with a complete dislocation of four frontal teeth [formula: see text] The dental formula was as follows: [formula: see text] Use of traditional splinting methods was impossible in this case.
Child↗
Recording compliance of dental splint use in obstructive sleep apnoea patients by force and temperature modelling.
Fibre-optic sensors are used to monitor the force and temperature of dental splints worn by patients suffering from sleep apnoea. Owing to the small size of the sensors, they can be easily embedded within the splint in a way that does not affect the effectiveness of the splint, and, at the same time, are able to indicate whether the splint has been properly worn by the patient. The overall dimensions of the sensor are approximately 0.375 mm thickness, 1 cm length and 3 mm width. The force and temperature sensors are calibrated and found to have sensitivities of better than 0.5 N and 0.1 degrees C, respectively. Trials performed on patients show that the measurement of pressure and temperature is an effective way of monitoring the proper usage of the dental splint by the patients.
Fiber Optic Technology↗
Technical and clinical assessment of the use of a new material-based splint in orthognathic surgery.
Heat or auto-cured acrylic resins are materials that are commonly used in splint construction. Newly developed light-cured resins hold promise in view of the altered characteristics of the material. The aim of this study was to evaluate how far light-curing resin-based splints can be used in orthognathic surgery. Over a period of 1 year, 141 orthognathic surgeries were planned and performed using randomly chosen light-cured splints versus auto-polymerized splints. The performance of splint fabrication, the model planning and the clinical use were assessed by different measurements. The dental technician, the orthodontist and the surgeon evaluated objective parameters (model damage, fabrication time, accuracy of registration, adjustment time) as well as subjective criteria (handling). This study revealed that the use of light-curing splints significantly improved the accuracy (97.7% versus 81.2% in the case of acrylic materials). Less time was needed for the fabrication and adjustment of the splint. There was concomitantly less model damage to be observed when light-curing resins were used (9.2% versus 83.5%) and subjective measurements revealed significantly better handling of light-curing resin-based splints. Light-curing resin splints used in orthognathic surgery seem to be advantageous.
Acrylic Resins↗
Management of obstructive sleep apnea in an edentulous patient with a mandibular advancement splint: a clinical report.
Literature on the treatment of obstructive sleep apnea in edentulous patients with a mandibular advancement splint is sparse. This clinical report describes a clinical and laboratory method of splint fabrication and discusses the rationale for its use.
Humans↗
Morphologic changes in the TMJ following splint wear.
Intraoral splints are a commonly used dental treatment for a variety of conditions. Because such splints alter the condyle-disc-fossa relationship, they probably change the loading status of the temporomandibular joint (TMJ), including the TMJ disc. Collagen, a major constituent of the disc, acts to resist tensile loading, and it is presumed that the fiber orientations of the individual disc bands reflect their functional loading. Therefore, the purpose of this study was to examine effects of intraoral splint wear on TMJ morphology in general, and collagen orientation of the intra-articular disc in particular. Young adult, female miniature pigs were divided into three groups: open-bite splint, protrusive-bite splint, and unsplinted control. Splints were worn for 2 months, after which the TMJ discs were harvested for histological examination and stereological analysis, and the skulls were cleaned. Although the splints had no effect on skull dimensions, changes were seen in the TMJs. The discs of the protrusively-splinted group showed an increased thickness of the posterior band (P < 0.015) and minor changes in collagen orientation of the anterior band. The most striking change was the presence of a degenerative osseous defect on the medial side of the mandibular condyle in half of the splinted animals. These results indicate that prolonged splint wear can induce remodeling and even injury of TMJ tissues.
Animals↗
A common-sense approach to splint therapy.
Splint therapy is a proven modality for alleviating the pain of many types of temporomandibular disorders and bruxism, though questions still remain regarding how splints work. In this article, a review of the literature is used to determine an effective splint design for the different degrees of temporomandibular problems. Sufficient credible literature exists to help provide an understanding of and a treatment protocol for the use of splints for temporomandibular disorders and bruxism problems.
Bruxism↗