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In-vitro investigations on suitability of light-cured resins for interocclusal splints: part I: mechanical properties.

OBJECTIVE: It was the aim of the present study to investigate the material properties of different resins and their suitability for the fabrication of occlusal and intermaxillary splints. MATERIAL AND METHOD: We subjected auto-polymerized resins (Palapress, Orthocryl, Steady-Resin M) and light-polymerized resins (Acrylight, Primosplint, Triad TranSheet Colorless and Pink) to investigation. The Targis Power light oven was used to polymerize the light-cured resins. After the auto-polymerized resins had been mixed by hand and filled into the forms, they were polymerized for 15 minutes in a high-pressure polymerization machine (Palamat) at 2 bar. The parameters examined were flexural strength, water adsorption, and polymerization shrinkage. Tests carried out according to DIN EN ISO 1567 served to determine flexural strength, flexural modulus, and water adsorption. Polymerization shrinkage was determined via the buoyancy test. RESULTS: The resins' flexural strength ranged from 60 to 101 MPa. Flexural moduli lay between 1.3 and 5.3 GPa. The water adsorption noted in light-cured resins amounted to 2.1-4.6 mass percent. Palapress and Steady-Resin displayed the lowest water adsorption with 2.0 mass percent. The light-polymerized resins revealed significantly less shrinkage (p < 0.05) than the autopolymerized resins tested in this study. CONCLUSION: Our results demonstrate that the light-cured resins-with the exception of Acrylight -easily match and even exceed the material properties of the cold-polymerized resins regarding flexural strength, flexural modulus, water adsorption and polymerization shrinkage. The light-cured resins examined thus seem suitable for use as splint material.

Absorption↗

The effects of intraoral splints on the masticatory system of pigs.

While evidence exists to support the effectiveness of splints on conditions involving the masticatory musculature, few research projects have examined the results of long-term splint wear. The purpose of this study was to examine the function of the masticatory system over a 2-month time period of splint wear. Young adult female miniature pigs were divided into three groups: a control (C) group that wore no intraoral splint, a control splint (CS) group that wore a splint increasing bite height, and a protrusive splint (PS) group that wore a splint increasing bite height and moving the mandible anteriorly. Splints were worn constantly. Fine-wire needle EMG was performed prior to splint delivery and at 1 and 2 months post-splint delivery. Bilateral superficial masseters and zygomaticomandibularis (ZM, equivalent to deep masseter) muscles were monitored during normal feeding. Absolute EMG output, percentage output, and cycle timing were unaffected by chronic splint wear. However, chewing coordination was significantly changed in the splinted groups in both sessions post-splint delivery relative to baseline readings and to the C group (P < 0.005). Trends indicate that the coordination of the PS group was more greatly altered than that of the CS group.

Animals↗

Changes in vertical tooth position and face height related to long term anterior repositioning splint therapy.

This study evaluates whether extended full-time wear of a partial coverage mandibular anterior repositioning splint (MORA) causes intrusion of posterior teeth and determines the effect on jaw position. Sixty-four patients from two private orthodontic practices were studied using cephalometric radiographs to measure vertical change in position of the anterior and posterior teeth and the mandible. The splint wear time ranged from a minimum of one half year to a maximum of 4.8 years, with a mean of 1.33 years. No significant change was recorded in the distance from the mandibular molar to the mandibular plane. On average, the maxillary incisor and maxillary molar extruded about 1 mm, while the mandibular molar was unchanged and the mandibular incisor intruded about 0.6 mm. Posterior face height increased an average of 1.6 mm, and anterior face height increased an average of 2.7 mms. In 20% of the patients, intrusion of the mandibular molars of 1 mm or more occurred. In 41%, extrusion of the maxillary incisors of 1 mm or more was noted. Intrusion of the upper molars or extrusion of the lower incisors occurred in only 5% of the patients. The data indicates that only a very small proportion of patients having long term splint therapy using the MORA have clinically significant molar intrusion. Change in mandibular position was expressed in a vertical increase in posterior and anterior face height. Only very small changes occurred in antero-posterior position.

Adolescent↗

The effect of splint therapy on TMJ position measured by the Gerber Resiliency Test.

The Gerber Resiliency Test is a clinical approach to possible evaluation of compression or distraction in the temporomandibular joints. In this study the same principle was used to check the tendency of mechanical responses of joints to the use of bite-splints. Sequences of tests were performed on 18 adult patients of the UTHSCSA clinical pool who had been previously treated for splint therapy. From this population nine patients presented one or more symptoms of TMD and nine were free of symptoms. Separation of the molars with the use of one thickness of tin foil indicated tendency to compression in the joints and three or four thicknesses to distraction. The tests were performed during delivery of the appliance and 1 week later. One sample chi-square statistical test was performed and did not show any statistically significant difference between dysfunction and non-dysfunction groups (P < .05). At delivery, there was a higher frequency of distraction in both left and right joints (P < .05) when the splint was inserted. Compression was present at very low frequency. One week later, the joints did not stay distracted in the same frequency.

Adult↗

Effect of anterior repositioning splints on the electromyographic activities of masseter and anterior temporalis muscles.

The effect of anterior repositioning (AR) splint therapy on masticatory muscle activity was investigated in seventeen patients with internal derangement; disk displacement with reduction in particular. Integrated electromyography (EMG) recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in intercuspal position before and after eight week treatment period, EMG recordings were taken for each subject prior to the beginning of clinical therapy and final EMG recordings were made without AR splint to provide a standard for comparison. The results of the investigation revealed the following: 1. AR splint therapy did not cause any significant modification of the EMG activity in the recorded muscles during maximal biting in intercuspal position; 2. Before and after treatment the EMG activity from the masseter muscle was less than from the temporal muscle; 3. AR splint therapy resulted in reduction of the pain (88.2%) and jaw joint sounds (64.7%) and mean vertical opening which was 42.17 mm before treatment increased to 45.06 mm.

Adult↗

[A rapid prototype fabrication method of dental splint based on 3D simulation and technology].

The conventional design and fabrication of the dental splint (in orthognathic surgery) is based on the preoperative planning and model surgery so this process is of low precision and efficiency. In order to solve the problems and be up to the trend of computer-assisted surgery, we have developed a novel method to design and fabricate the dental splint--computer-generated dental splint, which is based on three-dimensional model simulation and rapid prototype technology. After the surgical planning and simulation of 3D model, we can modify the model to be superior in chewing action (functional) and overall facial appearance (aesthetic). Then, through the Boolean operation of the dental splint blank and the maxillofacial bone model the model of dental splint is formed. At last, the dental splint model is fabricated through rapid prototype machine and applied in clinic. The result indicates that, with the use of this method, the surgical precision and efficiency are improved.

Computer-Aided Design↗

Biomechanics of pivoting appliances.

The effects of fulcrum-type splints on the temporomandibular joints are unclear. An analysis of bilateral temporomandibular joint linear tomograms of 20 volunteers was made. This study was carried out to evaluate and quantify the condylar distraction caused by the use of interocclusal splints with pivots located simultaneously on second molars. Statistical results showed an average condylar lowering of 1.3 mm in 87.5% of the subjects (P < .05) while clenching with lips closed and wearing this splint. A real bilateral condylar distraction was shown in 30% of the subjects, 35% showed both condyles in a protruded position, and 35% of the subjects showed a combined situation.

Adult↗

Management of nonreducing temporomandibular joint disk displacement. Evaluation of three treatments.

OBJECTIVE: The purpose of this study is to evaluate the responses of patients with anterior disk displacement without reduction to natural course, stabilization splint, and surgery. STUDY DESIGN: Thirty-one patients refused any treatment (natural course group), 20 patients were treated with a stabilization splint (stabilization splint group), and 24 patients who had not responded to nonsurgical treatment for a mean period of 19.0 months underwent surgery (surgical group). The success rate was evaluated in each of the three groups. RESULTS: The success rate was 41.9% in the natural course group, 55.0% in the stabilization splint group, and 76.9% in the surgical group. CONCLUSIONS: No statistically significant benefit from treatment with a stabilization splint over no treatment was identified although both groups of patients experienced alleviation of discomfort. The patients who had not responded to nonsurgical treatment for a mean period of .19 months benefited from surgery.

Adolescent↗

Parameters of tooth mobility in cases of normal function and functional disorders of the masticatory system.

Tooth mobility was measured mechano-electronically with the aid of quasi-static and dynamic methods in 309 patients comprising 2650 teeth being periodontally healthy. Besides, clinical and roentgenographic findings were ascertained to relate functional features to each periodontium. In general the result was that teeth loaded excessively show increased mobility parameters compared to those loaded normally. However, the mobility of teeth loaded poorly or deficiently was even greater compared to teeth stressed excessively. Moreover, follow-up studies showed that tooth mobility decreases after removal of functional disorders of the masticatory system or an immobilisation of splinted teeth. An experimental trauma of the periodontal ligament also brings on an increased tooth mobility which decreases to the original values some days after the trial.

Adolescent↗

Use and abuse of bite splints.

Bite splints are often used in the treatment of patients with oral parafunctions, temporomandibular joint (TMJ) dysfunction, or temporomandibular disorders. The most common reasons for prescribing a bite splint are to protect the teeth in patients with bruxism, to improve jaw-muscle and TMJ function, and to relieve related pain. The risk for negative side effects is small in conservative bite splint treatment. Complications from long-term use of splints, however, can be severe and irreversible. The risks are especially high when mandibular advancement splints, or splints that make contact only with parts of the opposing dentition, are used for more than 4 to 6 weeks without appropriate supervision. As a general rule, a dentist should not encourage a patient to use any type of splint for more than a few months except for cases in which the teeth need to be protected because of persistent oral parafunctions. Appropriate record keeping, including signed consent forms, is necessary; when neglected, it becomes difficult for the dentist to defend himself from false accusations of malpractice.

Bruxism↗

The cephalometric morphology of patients with obstructive sleep apnoea (OSA).

This prospective study analysed the lateral cephalometric radiographs of 59 dentate, white, Caucasian males. Thirty-five patients with proven obstructive sleep apnoea (OSA) formed the experimental group, while 24 subjects with no history of respiratory disease acted as controls. Radiographs were traced and digitized, and both hard and soft tissue features were compared between the groups. The pooled data were then subjected to discriminate analysis. Although conventional cephalometric measurements did not differ between the two groups, significant reductions were found in the lengths of the mandibular body and cranial base and in cranial base angulation in OSA subjects. The width of the oropharynx was significantly narrower in this group, particularly in the post-palatal region. The area of the soft palate was increased although that of the tongue was not. Intermaxillary space length (the distance between the posterior pharyngeal wall and the tip of the lower incisor) was decreased, and thus the area in which the tongue had to function was smaller in OSA subjects. From the discriminant analysis, two four-variable models were derived, both of which provided 100 per cent discrimination between the OSA and normal subjects. For the first model the entire OSA group was used: for the second, only obese OSA subjects (those a body mass index > 25) were chosen. The combination off a short mandible and intermaxillary space, with an enlarged soft palate but decreased pharyngeal airway has relevance to the effective management of OSA. In selected patients, advancement of the lower jaw by a nocturnal mandibular repositioning splint may be indicated. The orthodontist would seem to be in a unique position to assist in both the identification and treatment of these subjects.

Adult↗

Orofacial complications associated with forward repositioning of the mandible in snore guard users.

Snoring and obstructive sleep apnea (OSA) result from a collapse of the tongue, soft palate, and pharynx, causing temporary airway blockage. Acrylic mandibular advancement splints and Herbst appliances are used to relieve snoring and mild OSA. Repositioning the mandible forward may have an adverse effect on the orofacial and dentoalveolar structures of susceptible individuals. This article reports two cases in which orofacial complications developed following the utilization of snore guard appliances.

Dental Occlusion, Traumatic↗

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint.

AIM: To determine in detail the complications associated with the use of mandibular repositioning splints (MRS) to treat sleep-related breathing disorders. METHOD: This prospective cross-sectional cohort study audits the management with mandibular repositioning splints of 121 patients suffering from sleep-related breathing disorders. Investigation of patients' and sleeping partners' perspectives on treatment was undertaken with the use of a questionnaire based study. RESULTS: Sixty-eight per cent of respondents reported that they were compliant with treatment; various side effects were reported of which excess salivation was the most common. Investigation of sleeping partners' perspectives revealed that 70% felt that their partners' snoring was improved and 47% felt that their partner's breathing pauses during sleep were reduced. Sixty-four per cent of the sleeping partners also reported that their own sleep pattern had improved since their partner's treatment. CONCLUSION: Mandibular repositioning splints used in the manner described by this paper are demonstrated to have a good compliance rate, provide successful treatment and exhibit only minor, reversible side effects.

Adult↗

Treatment of joint pain and joint noises associated with a recent TMJ internal derangement: a comparison of an anterior repositioning splint, a full-arch maxillary stabilization splint, and an untreated control group.

Pain and joint noises associated with temporomandibular joint (TMJ) internal derangement are often treated by using an intra-oral splint. This study evaluated whether an anterior repositioning splint (AR splint) could be more effective in the treatment of these symptoms than a full-arch maxillary stabilization splint (FAMS splint), because of its capability to re-establish immediately the normal condyle/disk relationship. The authors treated 40 patients (average age 16.8; range 8.0-24.0) with confirmed internal derangement, joint pain, and joint noises in at least one TMJ for at least two months, with AR splint (20 subjects) or FAMS splint (20 subjects); 10 untreated patients comprised the control group. Joint noise, joint pain, and the intensity of pain were assessed using a visual analogic scale (VAS), and the pain was characterized (i.e., constant or chewing/biting pain) and evaluated monthly for eight months. Significantly fewer AR splint patients experienced pain after four months of treatment. A significantly lower intensity of pain was experienced by the AR splint patients after two months of treatment. Significantly fewer AR splint patients experienced chewing/biting pain after eight months of treatment. The frequency of joint noises decreased over time, with no significant differences between the groups. In conclusion, the AR splint seems to be more effective in decreasing pain, but it seems to make no difference in the treatment of joint noises.

Adolescent↗

[Jaw position in stabilization splint treatment of musculoskeletal disorders].

Stabilization splints are often used to treat musculoskeletal disorders of temporomandibular joints. Historically, the centric relation is advocated as the reference position for a stabilization splint. Centric relation as the reference position is subject of discussion, since this position has been defined for a healthy stomatognathic system. In case of temporomandibular disorders, the temporomandibular joints and muscles are compromised. Apart from degenerative changes in all components of the temporomandibular joints, the presence of pain may influence the establishment of a therapeutic position. In this article the biological plausibility of the centric relation as a reference position in patients suffering from temporomandibular disorders, is discussed. It is advocated to maintain the existing occlusion.

Cartilage, Articular↗

Nonlinear finite element analysis of a splinted implant with various connectors and occlusal forces.

PURPOSE: The aim of this study was to analyze the biomechanics in an implant/tooth-supported system under different occlusal forces with rigid and nonrigid connectors by adopting a nonlinear finite element (FE) approach. MATERIALS AND METHODS: A model containing 1 Frialit-2 implant (placed in the second molar position) splinted to the mandibular second premolar was constructed. Nonlinear contact elements were used to simulate a realistic interface fixation between the implant body and abutment screw and the sliding keyway stress-breaker function. Stress distributions in the splinting system with rigid and nonrigid connectors were observed when vertical forces were applied to the tooth, pontic, implant abutment, or complete prosthesis in 10 simulated models. RESULTS: The displacement obtained from the natural tooth increased 11 times than that of the implant, and the peak stress values within the implant system (sigmaI, max) increased significantly when vertical forces acted only on the premolar of a fixed prosthesis with a rigid connector. The sigmaI, max values seen in the splinting prosthesis were not significantly different when vertical forces (50 N) were applied to the pontic, molar (implant) only, or the entire prosthesis, respectively, regardless of whether rigid or nonrigid connectors were used. Moreover, the peak stress values in the implant system and prosthesis were significantly reduced in single- or multiple-contact situations once vertical forces on the pontic were decreased. DISCUSSION: The compensatory mechanism between the implant components and keyway sliding function of the implant/tooth-supported prosthesis could be realistically simulated using nonlinear contact FE analysis. The nonrigid connector (keyway device) significantly exploited its function only when the splinting system received light occlusal forces. CONCLUSION: Minimization of the occlusal loading force on the pontic area through occlusal adjustment procedures to redistribute stress within the implant system in the maximum intercuspation position for an implant/tooth-supported prosthesis is recommended.

Bicuspid↗

A growth control approach to Class II, Division 1 cases during puberty involving the simultaneous application of maxillary growth restriction and mandibular forward induction.

A simple method that used headgear and a functional appliance simultaneously was used for the correction of Class II, Division 1 cases with severe denture base discrepancy. The treatment restricted the forward growth of the maxilla and advanced the mandible. The functional appliance, referred to as the mandibular growth advancer (MGA), advances the mandible progressively with a splint, with the objective of remodeling the condyle and the glenoid fossa in the temporomandibular joint. Functional adaptation was achieved as the muscles that are attached to the mandible adjusted to new positions. In the two cases that illustrate this method, the ANB angle decreased and the Ar-B distance increased over a short period to four and six times the mean Japanese growth rate, respectively. After the correction of the denture-base discrepancy, a multibracket fixed appliance was used for dental alignment, and good skeletal, occlusal relationships and profiles were obtained. Treatment of severe denture-base discrepancy in this manner may reduce the skeletal abnormality, decrease the number of extraction cases, and shorten the subsequent multibracket treatment time. And it may reduce the iatrogenic side effects caused by prolonged mechanotherapy with a fixed appliance.

Acrylic Resins↗

[Dental device (sleep splint)].

Sleep splint, which is a dental device made of regin, is now widely used for the treatment of obstructive sleep apnea in our country. This device is worn in the mouth at night and makes the upper airway opened during sleep. It enlarges the velopharyngeal space as well as the space at the tongue base and prevents the collapse of the upper airway. This device is a treatment of choice for the patients with mild or moderate types of obstructive sleep apnea who are not treated ordinarily by nasal CPAP. When the patients have nasal obstruction, adenoid hypertrophy, enlarged tonsils, or improper conditions of the teeth, sleep splint is not indicated for those patients. At first, nasal obstruction should be treated, and the adenoids and enlarged tonsils should be removed surgically. The compliance of this treatment is better than that of nasal CPAP, and the major complication of this treatment is almost none.

Humans↗