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PubMed2005

Clinical comparison between two different splint designs for temporomandibular disorder therapy.

OBJECTIVE: To compare splint therapy in temporomandibular disorder (TMD) patients using two splint designs. MATERIAL AND METHODS: In a double-blind randomized parallel trial, 40 consenting patients were selected from the dental faculty pool of TMD patients. Two splint designs were produced: an ordinary stabilization (Michigan type) and a NTI (Nociceptiv trigeminal inhibition). The differences in splint design were not described to the patients. All patients were treated by one operator. A separate, blinded, examiner assessed joint and muscle tenderness by palpation and jaw opening prior to splint therapy, and after 2 and 6 weeks' and 3 months' splint use during night-time. The patients reported headache and TMD-related pain on a visual analog scale before and after splint use, and were asked to describe the comfort of the splint and invited to comment. RESULTS: Thirty-eight patients with mainly myogenic problems were observed over 3 months. A reduction of muscle tenderness upon palpation and self-reported TMD-related pain and headache and an improved jaw opening was seen in both splint groups (p < 0.05; paired t-test and Wilcoxon signed-ranks tests). There were no changes for TM joint tenderness upon palpation. No differences were noted between the two splint designs after 3 months for the chosen criteria of treatment efficacy (p > 0.05; Mann-Whitney U-test). CONCLUSION: No differences in treatment efficacy were noted between the Michigan and the NTI splint types when compared over 3 months.

Adult↗
PubMed1992

Rigidity of various fixation methods used as dental splints.

Horizontal and vertical rigidity of teeth fixed with seven types of dental splints were evaluated by two tooth mobility measuring devices. Altogether 21 dissected sheep mandibles including soft tissues were used for the experiments in which Fermit, flexible wire-composite, Kevlar, Fiber, Protemp, rigid wire-composite and Triad Gel splints were applied to four incisors. The mean rigidity of the central incisors within the splint was measured by means of Mühlemann periodontometer (horizontal mobility) and Periotest (horizontal and vertical mobilities). Mobility values of teeth before splinting were used as covariants and the values with the splints were illustrated as adjusted mobility. Statistical significance between the rigidity of various splints was analyzed by an unpaired t-test. It was shown that the most rigid splints both in horizontal and vertical directions were Triad Gel, rigid wire-composite and Fermit splints. Kevlar and Fiber splint allowed more horizontal movement than other splints. Protemp and flexible wire-composite splints proved to produce adequate lateral support for the fixed teeth and allowed vertical flexibility which is experimentally known to improve periodontal healing of luxated teeth.

Acrylic Resins↗
PubMed2004

Occlusal splint therapy and magnetic resonance imaging.

AIMS: To investigate the efficacy of the anterior repositioning splint and the canine-protected splint in relieving the signs and symptoms of anterior disc displacement with reduction, and to evaluate the effects of both splints on disc position using a standardized magnetic resonance imaging measurement technique. MATERIAL AND METHODS: A sample of 18 adult subjects was studied. The joint disorder was dually diagnosed via pretreatment clinical examination and magnetic resonance imaging. The sample was randomly divided into two groups. In the first group, each subject received an anterior repositioning splint; in the second group, each subject received a canine-protected splint. The treatment lasted 3 months. A standardized magnetic resonance imaging 10-step procedure was developed. Posttreatment clinical examinations and magnetic resonance imagings were done. Pretreatment and posttreatment records were statistically compared. RESULTS AND CONCLUSIONS: Both types of splints were effective in eliminating pain and clicking. All magnetic resonance imaging measurements showed that the canine-protected splint was superior to the anterior repositioning splint, as it allowed the articular disc to resume its normal length and shape while moving in a posterior direction toward recapture. Disc recapture was demonstrated via magnetic resonance imaging in 25% of the subjects from the anterior repositioning splint group, in 40% of the subjects from the canine-protected splint group, and in 33.3% of the subjects from both groups. Thus, noninvasive treatment techniques (such as occlusal splint therapy) might be the treatment of choice for anterior disc displacement with reduction.

Adolescent↗
PubMed1982

Effect of localized trauma and temporary splinting on immature skeletal muscle and mobility of the femorotibial joint in the dog.

The right pelvic limbs of 2 groups of dogs were splinted in extension for 2 weeks. In 1 of these groups, the dogs were anesthetized and the distal portion of the quadriceps femoris muscle was traumatized before splinting. Two groups of control dogs were also used; neither group was splinted, but 1 group was anesthetized, and their muscles were traumatized. The range of motion of the femorotibial joint was measured in all 4 groups before splinting and 3 and 9 weeks after splinting. Types I and II muscle fiber diameters and percentages were also recorded at 3 and 9 weeks in all groups. Flexion of the femorotibial joint was limited after splinting (P less than 0.001), but less so after trauma and splinting than after splinting alone (P less than 0.0001). A reversible type I fiber atrophy occurred in most restricted muscles (P less than 0.001) and early type II fiber atrophy was seen in a few muscles after trauma and splinting (P less than 0.002). Multifocal fiber necrosis was the only irreversible change seen after 3 weeks of splinting with or without concurrent muscle trauma. Relative fiber percentages did not change appreciably during splinting or recovery.

Animals↗
PubMed2002

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↗
PubMed1998

Digital assessment of occlusal wear patterns on occlusal stabilization splints: a pilot study.

STATEMENT OF PROBLEM: If masticatory load distribution is task-dependent, then the pattern of wear on an acrylic resin occlusal splint over time may affect clinical outcome. PURPOSE: This pilot study quantitatively assessed posterior wear after 3 months on the occlusal surfaces of maxillary stabilization splints. MATERIAL AND METHODS: Subjects with known history of nocturnal bruxism were given heat-cured full-arch acrylic resin occlusal stabilization splints to be worn nocturnally for 3 months. Splint occlusion was adjusted at appliance delivery and was refined at the baseline session 1 to 2 weeks later. No further adjustment of the splint surface was performed during the 3-month study period. Sequential impressions of the splint occlusal surface provided epoxy resin models that were digitized and analyzed through specialized software. Changes in the digitized splint surface from baseline to 3 months allowed comparison of wear facets between splint sides and among tooth locations. RESULTS: Splint wear was asymmetric between sides and uneven between dental locations. CONCLUSIONS: For full coverage occlusal splints, the appliance wear phenomenon can be site specific and, if left undisturbed, may yield two extremes of high wear and a zone of low wear in-between.

Acrylic Resins↗
PubMedDate not supplied

A supination splint worn distal to the elbow: a radiographic, electromyographic, and retrospective report.

The purposes of this study were to 1) describe a dynamic supination splint that does not cross the humeroulnar and humeroradial joints, allowing flexion and extension of the elbow; 2) provide retrospective data on effectiveness of this splint in patients with limited supination; and 3) provide data from radiography and electromyography (EMG) that document this splint's ability to provide a passive supination force. Eleven subjects treated for various elbow and/or wrist fractures leading to losses of forearm supination significantly increased their passive range of motion (PROM) from 34.0 degrees at the initial visit to 82.3 degrees at discharge and active range of motion (AROM) from 27.0 degrees to 72.3 degrees. Radiographic images of the radius and ulna were identical in maximal voluntary supination and resting in the splint. Surface EMG was used to measure supinator muscle activity at rest, passively supinated while wearing the splint, and during a maximal isometric supination effort (without splint). Average supinator EMG activity was 7.9 mV at rest, 7.8 mV in the splint, and 68.0 mV with maximal isometric contraction. Results indicate the supination splint is clinically effective in increasing supination PROM. EMG data and radiographs indicate that the splint passively positions the forearm in supination even though the proximal margin of the splint does not cross the elbow.

Adult↗
PubMedDate not supplied

A history of splinting: to understand the present, view the past.

The purpose of this study was to identify, using an intensive literature review, the primary historical factors and events that shaped the evolution of current splinting technique and practice. Publication dates determine the chronological order of events, and splints are defined according to the ASHT Splint Classification System. Purposes of splinting are analyzed and listed according to frequency of citation in splint manuals and books, and a historical review of splinting practice describes splints, events, and persons who influenced the evolution of splinting from the time of Hippocrates through the 20th century. Factors influencing splint development include disease, political conflict, advancements in medicine and technology, agency and organizational decision making, centers of practice, and availability of information. Infection, polio, war, technology, plastics, surgical advances, soft tissue remodeling, anatomy, biomechanics, government agencies, hand centers, seminars, professional organizations, publications, and a classification system have all played important roles in 20th century splinting practice.

History, 15th Century↗
PubMed2006

Static progressive splinting for posttraumatic elbow stiffness.

OBJECTIVES: To determine the value of static progressive splinting in helping patients with posttraumatic elbow stiffness regain functional motion and avoid operative treatment for stiffness. DESIGN: Retrospective case series. SETTING: Level I Trauma Center. PATIENTS AND INTERVENTION: Over a 3-year period, 29 consecutive patients with elbow stiffness after trauma (flexion contracture greater than 30 degrees or flexion less than 130 degrees) were treated with static progressive elbow splinting when a standard exercise program was no longer achieving gains in motion. Three patients were treated after the injury alone; 14 were treated after operative treatment of the initial injury, and 12 after a secondary operative contracture release for posttraumatic stiffness. Splinting was initiated on an average of 55 days (range, 15 to 200 d) after injury or operative treatment. MAIN OUTCOME MEASUREMENTS: Ulnohumeral range of motion before and after splint treatment. RESULTS: The flexion arc improved from 71 degrees (range, 0 to 100 degrees) before splinting to 112 degrees (range, 20 to 150 degrees) after splinting. After splinting, 3 patients had a flexion contracture greater than 30 degrees and 10 patients (34%) had fewer than 130 degrees of flexion. Only 3 patients-2 with heterotopic bone and 1 with an associated ulnar neuropathy-requested an operation to address elbow stiffness. Patients who were splinted after the initial injury (n=17, average improvement (fl-ext)=51+/-37 degrees) regained greater motion during splint wear than patients treated after elbow capsulectomy (n=12, average improvement (fl-ext)=22+/-24 degrees). CONCLUSIONS: Static progressive splinting can help gain additional motion when standard exercises seem stagnant or inadequate, particularly after the original injury. Operative treatment of stiffness was avoided in most patients.

Adolescent↗
PubMed2002

Resorbable internal splint: an adjunct to primary correction of unilateral cleft lip-nasal deformity.

There is usually some relapse in position of the alar cartilage after primary repair of unilateral cleft lip. Therefore, preoperative or postoperative external splinting has been recommended to supplement either closed or open suspension of the alar cartilage. The authors present a method using a resorbable internal nostril splint to shield the positioned alar cartilage from deformational forces caused by scar, and thus avoiding the problems associated with external splinting. An internal nasal splint was placed in 15 infants during repair of unilateral complete cleft lip and nasal deformity. The nasal morphology was compared with that of 15 control patients who had the same nasolabial procedure without internal splinting. Average follow-up time was 20.4 months (range, 4 to 30 months). Photogrammetric analysis showed that asymmetry of the alar contours averaged 8.6 percent in the splinted patients, as compared with 23 percent for controls (p <0.01). Thus, alar asymmetry was decreased two-thirds in the splinted group. An internal resorbable nasal splint is an adjunct to open alar suspension in primary repair of the unilateral cleft lip nasal deformity. An internal nasal splint protects the corrected alar cartilage longer than an external splint and eliminates drawbacks, such as necrosis, cutaneous depression of the nostril sill, and patient noncompliance. This strategy of temporary internal support of healing cartilage has other applications.

Absorbable Implants↗
PubMed2006

Biomechanical effects of splint types on traumatized tooth: a photoelastic stress analysis.

This study was undertaken to assess the effect of splint type on stresses occurring around traumatized tooth by photoelastic stress analysis. Three semi-rigid splint types--a wire-composite splint, fiberglass splint and titanium trauma splint--were utilized for comparisons. Extracted left upper central and lateral incisors and the canine tooth of an otherwise healthy patient were embedded equidistantly in photoelastic resin. For all cases studied, a static axial and 20 degrees oblique force of 100 N was applied on the lateral incisor in separate sessions. The experiments were undertaken without any splint application (unsplinted, control) after which the splints, adhesively bonded to the labial aspects of teeth, were consecutively tested. During each loading sequence, generation of isochromatic fringes was observed in the field of a polariscope, and photographed by a digital camera. Quantification of fringes was performed on magnified images, transferred to a PC. Under vertical loading, the highest stresses in the apical regions were observed for the unsplinted and ribbond-splint groups, whereas the lowest fringes occurred with the use of orthodontic wire as a splinting medium. Titanium trauma splint had absolutely no effect on reduction of stresses, as the fringe orders were slightly higher than the unsplinted lateral tooth. The use of orthodontic wire resulted in lowest fringe orders around the traumatized tooth.

Biomechanical Phenomena↗
PubMedDate not supplied

A comparison of static and dynamic wrist splints using electromyography in individuals with rheumatoid arthritis.

This study compared strength, dexterity, and the muscle activation of individuals with rheumatoid arthritis (RA) when different splints were worn. Five persons with RA were observed in four splint conditions (none, static, hinged, spiral) during grip, pinch, and dexterity tests by recording muscle activity of eight muscles in the upper extremity using electromyography (EMG). Statistically significant differences were found in clinical tests when hinged (p<0.001) and spiral splints (p=0.02) were worn. Grip strength decreased when hinged splints were worn, whereas two-point pinch increased and dexterity improved on the Nine-Hole Peg Test with the spiral splint. Although no significant EMG differences were found during different splint conditions, wrist muscles were recruited more for grip, and shoulder muscles were used most during pinch and dexterity tests. Individuals with RA who wore splints had decreased grip when wearing hinged splints, but improved pinch and dexterity were found when the spiral splint was worn. Increased use of proximal shoulder muscles was observed during pinch and dexterity tests with and without splints.

Adult↗
PubMed2000

The provision of occlusal splints in primary dental care.

UNLABELLED: Occlusal splints (Michigan splints, night/bite guards or bite-raising appliances) can be an effective, inexpensive and reversible treatment for a wide range of dental problems. OBJECTIVE: The aim of this study was to analyse retrospectively the provision of occlusal splint ('Michigan' type) in general dental practice, following a prescription by a restorative dental consultant. METHOD: One hundred patients were recruited from consultant clinics in a department of conservative dentistry during 1995 and 1996. All patients were prescribed a maxillary, full-coverage, heat-cured, acrylic-resin splint (Michigan splint) as part of a treatment plan. An explanatory letter and questionnaire were sent to all patients and to their referring general dental practitioner in 1997 and 1998. RESULTS: A response rate of 79% was achieved in obtaining completed questionnaires from both patients and general dental practitioners. Of respondents 43% (34/79) received an occlusal splint of some form. A small proportion of the respondents (16.5% [13/79]) received a Michigan splint as prescribed. Irrespective of the type of appliance provided, most patients (82% [28/34]) found them helpful. Of those who did not receive an occlusal splint, 38% (17/45) of patients felt financial implications deterred them from obtaining an appliance. Other common reasons for non-provision included: patients felt that symptoms had improved (18% [8/45]) and patients did not agree with treatment (18% [8/45]). The general dental practitioners had similar opinions to their patients. DISCUSSION: These findings raise some serious doubts on the efficacy of consultant clinic advice in the prescription of occlusal splints in general dental practice. The financial and educational issues raised by this study will need to be addressed to improve service provision. CONCLUSION: The results of this study indicate that 16.5% of patient respondents prescribed a Michigan splint at a consultant clinic received such an appliance in general dental practice.

Comprehensive Dental Care↗
PubMed1992

Application of a shape memory alloy to hand splinting.

This paper describes new passive splints which have been developed using a shape memory alloy. The peculiar feature of the splints is that the way in which they change shape in use conforms to the stretching motion which it would be desirable to apply in certain conditions of deformity. The alloy consists of 55.66% by weight Nickel and 44.34% Titanium. The heat treatment of the alloy for memorising shape was implemented at 500 degrees C for one hour. This alloy was easily bent when cool, but the original shape was recovered on heating. It was used as the supporting structure of the reverse knuckle bender splint and the cock-up splint. The new splints could be easily attached to the deformed limb after cooling. The splints avoided the development of spasticity, because they gradually recovered their original shapes and corrected the deformities when the heat of the room or body heat warmed the splints. Since the shape memory alloy has the dual function of thermal sensor and kinetic power source it was a simple device. The splint was, as a result, small and smart. It was apparent from clinical use that the splint was easy to wear and could be worn with comfort for an extended period. The design of the splints and the fabrication process are described and their application is indicated.

Adult↗
PubMed2004

[A study of electric information monitoring in the treatment of bruxism with occlusal splint].

OBJECTIVE: An electric monitor of bruxism had been invented in order to evaluate the curative effect of cuspid occlusal upheaving splint and stabilization splint. METHODS: 20 patients with bruxism were randomly divided into two groups. A cuspid occlusal upheaving splint or a stabilization splint was fabricated respectively for patients. The vertical dimension for each splint was 0.5 mm lower than mandibular postural position. Sleeping time, bruxist time and times of bruxism were recorded with bruxism monitor that was invented for studying bruxing. RESULTS: The bruxist time and the times of bruxism were decreased obviously in patients with cuspid occlusal upheaving splint, while no significant difference was shown before and after using the stabilization splint. CONCLUSIONS: The bruxism monitor can automatically measure and record the data of bruxism with splint, which is valuable for clinic. The curative effect of cuspid occlusal upheaving splint is better than that of stabilization splint for treating bruxism.

Adult↗
PubMed2005

Laboratory comparison of a titanium trauma splint with three conventional ones for the treatment of dental trauma.

AIM: This was to evaluate the efficacy of a Titanium Trauma Splint (TTS) by comparing it with three other devices commonly used in the care of dental trauma, a Resin Splint (RS), Button-Bracket Splint (BS) and a Wire- Composite Splint (WCS). METHODS: The four types of splints were applied on experimental dental models, including in the splints the teeth from canine to canine of each maxilla. Two load-tests for each device were applied with the dental model inclined to 45 degrees or less, and increasing forces were applied to the incisal edges from 0N to 50N, in the first test, and from 0N to 100N in the second. At the same time the displacement involved of the splinted teeth was assessed and then the ratio between the two measured sizes was graphically represented. RESULTS: In the level tests the displacements of the splinted teeth caused by the force of 80N were: 0.39 mm for the BS, 0.37 mm for the TTS, 0.35 mm for the WCS and 0.30 mm for the RS. In the inclined tests, the splints under the effect of 40N, showed displacements as: 1.65 mm RS, 1.83 mm BS, 1.89 mm TTS and 2.16 mm WCS. CONCLUSION: With the exception of RS as to rigidity, the other three splints were practically the same in response. Considering other characteristics, the TTS proved to be a promising device for the treatment of dental traumas.

Composite Resins↗
PubMed1993

[Long term results of using splints for uniting loose teeth from composite materials].

61 splints made with the method AET strengthened with steel ligature used in uniting of loosened teeth in periodentopathies have been clinically evaluated. Splints from chemo-hardening materials were applied in 32 patients the observation period was from 5 to 10 years. Applying chemo-hardening materials 29 people had their teeth sutured and they were observed from 1 to 5 years. Mobility of splinted teeth, damage of the splint material, change of its colour and pain ailments connected with eventual splint damages and diseases of the pulp of the splinted teeth underwent evaluation. The long period of splints maintenance was the merit of the technology of making them and of the applied materials. In the observation period a little less mobility of teeth splinted in the case of application of light-hardening composites was observed. A greater number of mechanical damages and change of colour was noticed in splints from chemo-hardening materials. It was noticed that the applied materials are very helpful and safe in making splints uniting teeth with the damaged alveolodental ligament.

Acid Etching, Dental↗
PubMed2000

Effects of intraoral splint wear on proteoglycans in the temporomandibular joint disc.

Intraoral splints are a common dental treatment for dysfunctions of the temporomandibular joint (TMJ), but their effects on the structures of the joint, specifically the disc, have not been well investigated. This study examined proteoglycans (PGs) of the TMJ disc of the miniature pig and tested for alterations resulting from intraoral splint wear. Sixteen female pigs were divided into three groups: control (C), control splint (CS), and protrusive splint (PS). Splinted groups received chrome-cobalt ramp splints which were worn continuously for 2 months. PG content within various disc locations was determined by colorimeteric assay. PG synthesis and type were examined by labeling with (35)S-sulfate and SDS-PAGE analysis. Average water content of the disc was 77.1%, which places it at the high end of the normal range for collagenous biomaterials (60-80%). PGs migrating to the positions typical of aggrecan, biglycan, and decorin on SDS-PAGE were present in all locations of all groups. The highest content and synthesis of PGs were always found in the intermediate band of the disc regardless of group (P < 0.05), supporting the notion that this band encounters heavy compressive loading during function. The joints of animals from both splinted groups showed a high frequency of gross pathology. Biglycan synthesis was increased in both splinted groups (P < 0.05). Newly synthesized biglycan had a shorter migration distance in the intermediate bands of the CS group, suggesting increased hydrodynamic size. These findings suggest that intraoral splint wear may cause disc damage or remodeling.

Animals↗