Efficiency of mixed and rigid occlusal stabilization splints: Randomized clinical trial

Abstract Occlusal stabilization splints are the most common treatment for controlling the deleterious effects of sleep bruxism. This study aimed to evaluate the effectiveness of a low-cost, mixed occlusal splint (MOS) compared to that of a rigid splint. A randomized clinical trial was performed on 43 adults of both sexes with possible sleep bruxism and satisfactory dental conditions. They were divided into rigid occlusal splint (ROS) (n = 23) and MOS (n = 20) groups. Masticatory muscle and temporomandibular joint (TMJ) pain intensity (visual analog scale), quality of life (WHOQOL-BREF), indentations in the oral mucosa, anxiety, and depression (HADS), number of days of splint use, and splint wear were evaluated. All variables were evaluated at baseline (T0), 6 months (T6), and 12 months (T12) after splint installation (T0), and splint wear was evaluated at T6 and T12. Student's t-test, Mann-Whitney U test, non-parametric Friedman's analysis of variance for paired samples and pairwise multiple comparisons, Pearson's chi-square test, two-proportion z-test, non-parametric McNemar's and Cochran's Q, and Wilcoxon tests were used (p < 0.05). In both groups, there was a decrease in TMJ pain and pain intensity over time and improvements in the quality of life scores. At T6, there was a higher rate of splint wear in the MOS group than in the ROS group (p = 0.023). The MOS showed a higher rate of wear than the rigid splint but had similar results for the other variables. Therefore, the use of a mixed splint appears to be effective in controlling the signs and symptoms of sleep bruxism.

Comparison between Simple Planas Indirect Tracks and occlusal splints for treatment of temporomandibular disorder-related headache: a randomized controlled clinical trial / Comparação entre Pistas Indiretas Planas Simples e placas miorrelaxantes para tratamento de dor de cabeça relacionada à disfunção temporomandibular: ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder-related headache (TMDH) is a very common clinical condition which manifests as pain around the temples. The treatment recommended in dentistry is occlusal splint. However, there is a device generally used in functional jaw orthopedics, called simple Planas indirect tracks (SPIT), which has been shown to be efficient in managing these headaches. This clinical trial aimed to compare SPIT and occlusal splints in the treatment of TMDH patients. METHODS: This randomized clinical trial included thirty-seven women who had TMDH for more than one year into three groups: GPIT treated with SPIT, GSPLINT treated with a Michigan splint, and a control group (CG) submitted to no treatment. The randomization was paired, that is, each new individual was assigned to a group sequentially. The number of headache days per month, average pain intensity, pain response to masseter and temporalis palpation, and days of pain drug use were collected and analyzed. The follow-up lasted for 3 months. RESULTS: Thirty-seven patients were included but 4 dropped out during treatment and 33 underwent intervention. Patients in GPIT exhibited superior results compared to GSPLINT and CG, with significant differences between groups for almost all variables. In GPIT, the number of headache days was reduced by 87.43%, pain intensity by 66.67%, and days of drug use by 88.42%, with significant improvement in all parameters compared to CG. In GSPLINT, the number of headache days decreased by 44.46% and days of drug use by 36.63%, while pain intensity increased by 46.67%; however, there was no significant difference in any of the parameters compared to CG. CONCLUSION: SPIT may be a good treatment option for patients with TMDH since these appliances have shown much more consistent results than occlusal splints. Further studies and with more individuals will be needed to confirm these findings.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cefaleia secundária à disfunção temporomandibular (CDTM), é uma condição clínica muito comum, com dores nas têmporas. O tratamento padrão na odontologia são as placas miorrelaxantes, entretanto um aparelho da ortopedia funcional dos maxilares, chamado de Pistas Indiretas Planas Simples (PIPS), tem se demonstrado eficiente no controle dessas cefaleias. Este estudo clínico visou comparar as PIPS com as placas miorrelaxantes, no quadro álgico de CDTM. MÉTODOS: Este ensaio clínico randomizado incluiu 37 mulheres portadoras de CDTM há mais de um ano, que foram distribuídas aleatoriamente em três grupos: o GPIPS, no qual as pacientes foram tratadas com PIPS, o GPLACA, com uso de placas miorrelaxantes de Michigan e o grupo controle (GC), sem qualquer tratamento. A aleatorização foi pareada, sendo que cada participante era consecutivamente alocada em um grupo diferente. Foram coletados e analisados dias de cefaleia por mês, intensidade de dores, resposta álgica à palpação de masseter e temporal, bem como os dias de uso de fármacos. O acompanhamento foi de três meses. RESULTADOS: Das 37 pacientes iniciais, 4 desistiram do tratamento e apenas 33 foram submetidos a alguma intervenção. As pacientes do GPIPS apresentaram resultados muito superiores às do GPLACA e do GC, com diferenças significativas entre os grupos em quase todas as variáveis. No GPIPS, os dias de dor diminuíram 87,43%, a intensidade 66,67% e os dias de uso de fármacos analgésicos 88,42%, sendo estatisticamente significante a melhora em todos os parâmetros em relação ao GC. Já no GPLACA, os dias de dor diminuíram 44,46% e os dias de uso de fármacos 36,63%, mas a intensidade da dor aumentou 46,67%, porém sem diferença estatisticamente significante em nenhum parâmetro quando comparado ao GC. CONCLUSÃO: O uso do PIPS pode ser uma boa escolha de tratamento da CDTM, tendo apresentado resultados mais consistentes do que as placas miorrelaxantes. Mais estudos e com mais participantes são necessários para confirmar estes achados.

Evaluation of the mechanical properties of different materials for manufacturing occlusal splints

Abstract This study aimed to compare the mechanical properties of various occlusal plate materials by analyzing surface roughness, Knoop microhardness, flexural strength, and modulus of elasticity. Fifty samples were prepared and classified as SC (self-curing acrylic resin), WB (heat-cured acrylic resin), ME (acrylic resin polymerized by microwave energy), P (resin print), and M (polymethylmethacrylate polymer block for computer-aided design/computer-aided manufacturing). The data were analyzed using a one-way analysis of variance and Tukey's honestly significant difference test. Surface roughness was the same in all groups. The surface hardness of group M was statistically superior. The samples from groups P and M had higher flexural strength than other samples. The modulus of elasticity of group SC was statistically lower than that of other groups. The mechanical properties of the materials used to make the occlusal plates differed, and group M achieved the best results in all analyses. Therefore, clinicians must consider the material used to manufacture long-lasting and efficient occlusal splints.

Effect of laboratory and chairside polishing methods on the surface topography of occlusal splint materials manufactured using conventional, subtractive and additive digital technologies / Efeito de métodos de polimento em laboratório e em consultório na topografia de superfície de materiais de splint oclusal fabricados usando tecnologias digitais convencionais, subtrativas e aditivas

Objetivo: Este estudo avaliou as propriedades de polimento dos materiais de splint oclusal obtidos usando métodos de fabricação subtrativos e aditivos com os procedimentos de polimento laboratorial (LP) e polimento em consultório (CP). Material e Métodos: As amostras (N=180, n=60 para cada grupo) foram fabricadas usando um dos seguintes métodos: método de fabricação subtrativo (SMM) (M-PM Disc, Merz Dental GmbH), método de fabricação aditivo (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG) e o método de fabricação convencional (CMM) (Promolux HC, Merz Dental GmbH). Seguindo os procedimentos de LP e CP, a rugosidade da superfície dos espécimes foi medida usando um perfilômetro de superfície digital. Um espécime representativo foi selecionado de cada grupo, e uma imagem de microscópio eletrônico de varredura (SEM) foi obtida. Resultados: Tanto o método de fabricação quanto os procedimentos de polimento afetaram significativamente os resultados (P<0,01). Os termos de interação também foram significativos (P<0,001). Conclusão: Com ambos os métodos de polimento, a rugosidade superficial do grupo AMM foi a maior e a do grupo CMM a menor. Embora o procedimento CP tenha sido mais eficaz do que LP com ambos os métodos, a rugosidade da superfície ficou abaixo do limite de 0,2 µm após ambos os procedimentos de polimento testados (AU)

Objective: This study evaluated the polishing properties of the occlusal splint materials obtained using subtractive and additive manufacturing methods with the laboratory-type polishing (LP) and chairside-type polishing (CP) procedures. Material and Methods: Specimens (N=180, n=60 each group) were manufactured using one of the following methods: subtractive manufacturing method (SMM) (M-PM Disc, Merz Dental GmbH), additive manufacturing method (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG), and the conventional manufacturing method (CMM) (Promolux HC, Merz Dental GmbH). Following LP and CP procedures, surface roughness of the specimens was measured using a digital surface profilometer. One representative specimen was selected from each group, and a scanning electron microscope (SEM) image was made. Results: Both the manufacturing method and the polishing procedures significantly affected the results (P<0.01). Interaction terms were also significant (P<0.001). Conclusion: With both polishing methods, surface roughness of the AMM group was the highest and the CMM group the least. Although the CP procedure was more effective than LP with both methods, surface roughness was below the 0.2 µm threshold after both polishing procedures tested. (AU)

Modificación de la actividad metabólica por medio de un dispositivo intraoral en pacientes con hiperplasia condilar confirmada por SPECT / Metabolic activity modification by means of an intraoral device in patients with condylar hyperplasia confirmed by SPECT

Objetivo: Evaluar los efectos de la aplicación de un dispositivo intraoral de uso permanente en el comportamien- to de los cóndilos con hiperplasia condilar (HC) confirmada por tomografía computarizada de emisión por fotón único (SPECT), estableciendo una comparación con un grupo de pacientes con HC que no utilizó el dispositivo. Materiales y métodos: 30 pacientes con una edad promedio de 21,7 años (+/-5,56) con HC confirmada con SPECT fueron asignados al azar a dos grupos: a los del grupo I (n=18) se les colocó un dispositivo intraoral de uso perma- nente para modificar la posición de la mandíbula, mientras que a los del grupo II (n=12) no se les colocó ningún dispo- sitivo. Se realizaron evaluaciones de dolor, del desvío de la línea media, de la apertura máxima y del disconfort al inicio del estudio y a los 2, 4, 6, 10, 12 y 14 meses. A los 19 meses promedio, la actividad osteoblástica (AO) fue reevaluada me- diante SPECT. Resultados: En el grupo I, la AO en los cortes coro- nales y transversales cesó o disminuyó (p<0,001) respecto a la condición inicial, mientras que en el grupo II la AO au- mentó (p<0,001). Los datos fueron analizados utilizando el test de Wilcoxon de rangos signados. Al ajustar un modelo de ANCOVA robusto utilizando el valor inicial como covariable también se observa que el efecto del grupo fue estadística- mente significativo en ambos cortes (p<0,001). Conclusiones: La aplicación de un dispositivo intrao- ral de uso permanente mejora la evolución de la hiperplasia condilar, lo que lo puede convertir en un tratamiento de uti- lidad para el tiempo que se aguarda para realizar una condi- lectomía alta de cuello de cóndilo, o incluso para evitar este procedimiento (AU)

Objective: To evaluate the effects of the application of an intraoral device for permanent use on the behavior of con- dyles with condylar hyperplasia (CH) confirmed by single photon emission computed tomography (SPECT), establish- ing a comparison with a group of patients with CH that did not use the device. Materials and methods: Thirty patients with an aver- age age of 21.7 years (+/-5.56) with CH confirmed by SPECT were randomly divided into two groups: the ones in group I (n=18) received an intraoral device for permanent use to align the mandible, while those in group II (n=12) did not get any device. Pain, midline shift, maximum opening, and discomfort were evaluated at the beginning of the study and at 2, 4, 6, 10, 12, and 14 months. At an average of 19 months, osteoblastic activity (AO) was reassessed by SPECT. Results: In group I, the AO in the coronal and trans- verse sections ceased or decreased (p<0.001) in comparison to the initial condition, while in group II the AO increased (p<0.001). The data was analyzed by the Wilcoxon signed rank test. Adjusting a robust ANCOVA model using the ini-tial value as a covariate made it possible to observe that the effect of the group was statistically significant in both cuts (p<0.001). Conclusions: The application of an intraoral device for permanent use improves the evolution of condylar hyperpla- sia, which can make it a useful treatment until a high condylectomy of the neck of the condyle is performed, or even to avoid this procedure (AU)

Confección de férulas de descarga personalizadas por CAD-CAM / Customized CAD-CAM fabrication of occlusal splints

La elaboración de férulas de descarga con la utilización de la técnica convencional, basada en la mezcla de un monómero y polímero con el posterior curado de la mezcla, puede dejar restos de monómero que generen reacciones de hipersensibilidad en algunas personas sensibles a estos químicos. Así, el uso de la tecnología CAD-CAM (Diseño Asistido por Ordenador - Fabricación Asistida por Ordenador), puede mejorar el ajuste y confort relacionado con el uso del dispositivo por el paciente. En el siguiente artículo se presenta un método de elaboración de férulas basado en esta tecnología.

The production of occlusal splints using the conventional technique based on a monomer and polymer mixing with subsequent curing of the mixture may leave traces of monomer that generate hypersensitivity reactions in allergic people to these chemicals. Hence, the use of CAD-CAM technology can improve the fit and comfort related to the use of the device on the patient. In this article a splint elaboration method is shown based on this technology.

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

Dispositivos de Avance Mandibular para el Manejo del Ronquido y la Apnea del Sueño. Actitudes de los Odontólogos Generales y los Especialistas Médicos para Proporcionarlos

RESUMEN: El objetivo de este estudio fue determinar las actitudes y la conciencia de los odontólogos y especialistas médicos sobre la provisión de dispositivos de avance mandibular (DAM) para el tratamiento de los ronquidos y la apnea del sueño. Se llevó a cabo un estudio observacional descriptivo de corte transversal, donde se seleccionaron por conveniencia 53 odontólogos (generales y especialistas) y 5 médicos especialistas en medicina del sueño en la ciudad de Guadalajara, México. Quienes respondieron un cuestionario específico desarrollado por Jauhar et al. (2008) dirigido a conocer la actitud de los odontólogos y médicos especialistas para la provisión de los DAM y otros aspectos relacionados con el ronquido y la apnea obstructiva del sueño (AOS). El 94 % de los odontólogos respondió estar interesado en capacitarse en ronquido y AOS. Y en el grupo de los médicos especialistas se encontró que el 80 % cree que los odontólogos sí tienen un papel para ayudar a los pacientes con ronquido y AOS, el 60 % cree que los odontólogos pueden contribuir con la realización de DAM y el 40 % considera que los odontólogos deben remitir a un especialista del sueño. Existe una actitud muy positiva de los odontólogos para ser parte del grupo interdisciplinario para el tratamiento del ronquido y de la apnea obstructiva del sueño, pero este estudio nos muestra además que a pesar de la disposición para utilizar los DAM, la formación y capacitación no es suficiente. Por otra parte, hay una actitud positiva de los médicos especialistas que consideran que los odontólogos juegan un papel importante en ayudar a los pacientes con ronquidos o con apnea del sueño, pero se evidencia que en su gran mayoría no usan los DAM como parte de un posible tratamiento.

ABSTRACT: The objective of this study was to determine the attitudes and awareness of dentists and medical specialists on the provision of mandibular advancement devices (MAD) for the treatment of snoring and sleep apnea. This is a cross-sectional descriptive observational study, where 53 dentists (general and specialists) and 5 sleep medicine specialists in the city of Guadalajara, Mexico were selected for convenience. The selected group answered a specific questionnaire developed by Jauhar et al., to know the attitude of dentists and medical specialists for the provision of MAD and other aspects related to snoring and obstructive sleep apnea (OSA). 94 % of dentists responded to be interested in training in snoring and OSA. And of the group of medical specialists, 80 % consider that dentists have a role in helping patients with snoring and OSA, 60 % believe that dentists can contribute to MAD and 40 % believe that dentists should refer a sleep specialist. There is a very positive attitude by the dentists to be part of the interdisciplinary group for the treatment of snoring and obstructive sleep apnea, but this study also shows that despite the willingness to use MAD, education and training is not enough. There is a positive attitude of specialist doctors who consider that dentists play an important role in helping patients with snoring or with sleep apnea, but it is evident that the majority do not use MAD as part of a possible treatment.

Are exercises with or without occlusal splints more effective in the reduction of pain in patients with temporomandibular disorders of myogenic origin? A systematic review

Abstract Temporomandibular disorders (TMD) is a term used to describe a set of clinical conditions that may compromise the temporomandibular joint (TMJ) and masticatory muscles and/or associated structures, considered the most frequent cause of orofacial pain of non-dental origin. In recent years, many forms of physical therapy have been used in the treatment of TMD to reduce pain and improve the range of mandibular movement present in this impairment. Among these resources are kinesiotherapy (exercise), electrothermal and manual therapy, acupuncture, training posture, mobilizations, and biofeedback. Objectives To determine if exercises with or without occlusal splints are effective in reducing pain in patients with temporomandibular disorders (TMD) of myogenic origin. Methodology This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD 42019134244). Controlled trials published in PubMed, Scopus, and Cochrane Library following PRISMA guidelines up to April 2022 were randomized and included. The population above 18 years, which evaluated the effectiveness of exercise with or without occlusal splints in reducing pain in patients with TMD of myogenic origin, diagnosed through the Research Diagnostic Criteria for Temporomandibular Disorders, was also included. There was no restriction on the period of publication. Cochrane risk of bias analysis was performed. Results Of the five included articles, all showed a reduction of pain, but without significant differences between the interventions performed. Additionally, studies that evaluated the quality of life and mandibular movements showed a reduction in pain, but no significant differences between therapies. Conclusion The analyzed studies showed no difference in the improvement of pain, quality of life, and mandibular movements between the groups that performed only exercises or the associated treatments.

Management of bruxism associated with temporomandibular disorder: case report / Manejo do Bruxismo associado a Disfunção Temporomandibular: relato de caso

ABSTRACT Studies have found the association between episodes of bruxism and the presence of signs and symptoms of temporomandibular disorder (TMD). The aim of the present study was to report the diagnosis and palliative therapy of bruxism associated with TMD. Patient, 23 years old, male gender, presented at dental clinic, complaining of pain in the temporomandibular joint on the left side and alteration of the form of the anterior teeth. During the anamnesis it was documented that this symptom was recurrent and reported the habit of grinding teeth. The clinical examination observed discrepancy between the centric relation and the maximum habitual intercuspation, unsatisfactory protrusive guide, presence of wear facets, clicking and mandibular deviation during mouth opening. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) questionnaire was applied to diagnose TMD. By means of specific algorithms this disorder was classified as myofascial pain, disc displacement with reduction and osteoarthritis, all affecting the left side. Thus, it was proposed the assembly of the models in semi-adjustable articulator for occlusal mapping and waxing diagnosis, then the occlusal adjustment by selective wear and material addition was executed. After this procedure, the occlusal splint was installed as a palliative therapy for bruxism. This case report suggests that the dental approach by means of occlusal adjustment and occlusal splint, in a patient diagnosed with bruxism and temporomandibular disorder, reduces the signs and symptoms that affect the components of the Stomatognathic System.

RESUMO Estudos tem encontrado a associação entre os episódios de bruxismo e a presença dos sinais e sintomas de disfunção temporomandibular (DTM). O objetivo do presente trabalho foi relatar o diagnóstico e terapia paliativa do bruxismo associado à DTM. Paciente, 23 anos, gênero masculino, apresentou-se à clínica odontológica, queixando-se de dor na articulação temporomandibular do lado esquerdo e alteração da forma dos dentes anteriores. Durante a anamnese foi documentado que esse sintoma era recorrente e relatado o hábito de ranger os elementos dentais. No exame clínico observou-se discrepância entre relação cêntrica e máxima intercuspidação habitual, guia protrusiva insatisfatória, presença de facetas de desgaste, estalido e desvio mandibular durante o movimento de abertura bucal. O questionário Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) foi aplicado para diagnosticar a DTM. Por meio de algoritmos específicos essa desordem foi classificada como dor miofascial, deslocamento de disco com redução e osteoartrite, todos acometendo o lado esquerdo. Desta forma, foi proposto a montagem dos modelos em articulador semi-ajustável para mapeamento oclusal e enceramento diagnóstico. Em seguida o ajuste oclusal por desgaste seletivo e acréscimo de material foi executado. Finalizado esse procedimento, a placa estabilizadora da oclusão foi instalada como terapia paliativa para o bruxismo. Esse relato de caso sugere que a abordagem odontológica por meio do ajuste oclusal e placa oclusal, em paciente diagnosticado com bruxismo e disfunção temporomandibular, reduz os sinais e sintomas que afetam os componentes do Aparelho Estomatognático.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device / Uma nova abordagem via biofeedback para o controle do bruxismo de vigília e de enxaqueca crônica: utilização de um dispositivo interoclusal posterior em vigília

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.

Evaluation of pain intensity of the masticatory muscles after occlusal appliance and combined therapy: a 6-months follow-up pilot study

Masticatory muscle pain (MMP) is a common type of orofacial pain.Occlusal appliance (OA) is contemplated as a first-line conservative approach for chronic MMP, however, integrated biopsychosocial approaches such as counseling and self-care therapies (CSG) are also considered essential. Aim: This pilot study aimed to compare the use of a combined therapy (GSG + OA) and solely OA treatment on pain intensity related to chronic MMP over a 6-month follow-up. Methods:For this, 20 patients diagnosed with chronic MMP using the Diagnostic criteria for temporomandibular disorders (DC/TMD) were divided into 2 groups (n=10) and treated with OA or combined therapy (CoT; OA + CSG). Electromyographic muscle activity (EMG), visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded at baseline, 1, 3 and 6 months after treatment. Data was collected and statistical analysis were applied at a significance level of 5%. Results:Results showed no significant differences at baseline among groups for any assessment. VAS showed that both treatments decreased subjective pain in volunteers over time, but no significant differences among both groups were observed at any evaluation time. For electromyography, CoT and OA presented no significant differences throughout the experiment neither on relaxed muscle position or maximum volunteer contraction. Finally, a significantly higher PPT for CoT was found for all muscles at the last assessment point (p<0.05). Conclusion: These findings suggest that both treatments are effective for the reduction of pain perception (VAS) in patients with chronic MMP. However, the addition of CSG to an OA therapy may be more beneficial for the improvement of tenderness on the same patients, at least in a long-term basis (> 3 months). Notwithstanding, a larger study should be performed to substantiate these findings

Method and accuracy of determining the jaw position of repositioning splint with the aid of digital technique / 北京大学学报(医学版)

OBJECTIVE@#To establish the workflow of determining the jaw position of repositioning splint with the aid of digital technique, and to evaluate the accuracy of this workflow and compare the accuracy of raising different vertical dimensions in vitro.@*METHODS@#A volunteer was recruited. The data of full-arch scans, cone beam computed tomography (CBCT) image and ultrasonic jaw motion tracking of the volunteer were acquired. The full-arch scans were merged with the CBCT image, which were then matched to the jaw motion tracking reference system. The jaw position of repositioning splint was determined when the anterior teeth opening was 3 mm and the condyle was in centric relation of the fossa in the sagittal plane. A digital repositioning splint was designed in the software based on virtual articulator and fabricated with additive manufacturing technique. After the splint was tried in, another CBCT image was taken and a qualitative analysis was conducted to compare the position of condyle between these two CBCT images. In the in vitro study, standard dental plaster casts with resin ball markers attached to the base were mounted onto a fully adjustable articulator in the intercuspal position. The dental casts were scanned by an extraoral scanner to establish digital models. The ultrasonic jaw motion tracking device was used to obtain simulated jaw movements on the articulator, which was repeated for three times. The digital models and data of jaw movements were merged in one coordination with the aid of bite forks. The jaw position of repositioning splint was determined by adjusting data of jaw movements, each of which was used to determine three vertical jaw positions 4 mm, 5 mm, and 6 mm with the horizontal jaw position of protrusion 2 mm. The virtual articulators with differently adjusted jaw movements were applied in designing repositioning splints, and the final repositioning splints and virtual jaw relationships were exported in STL format. Then the repositioning splints were fabricated with additive manufacturing technique and tried in plaster casts on the mechanical articulator, which were scanned and the jaw relationships on the mechanical articulator were exported later. The virtual jaw relationships and scanned jaw relationships were registered according to lower models and displacement of upper models was calculated. Ball markers were fit to acquire the coordinates of centers and absolute difference values of centers along three coordinating axes X, Y, and Z were calculated. One-way analysis of variance was conducted using SPSS 18.0 software to compare deviations of the three different vertical jaw relationships in two-side test and the significance level was 0.05.@*RESULTS@#With the aid of multi-source data fusion and individualized jaw motion, the clinical workflow of determining jaw position of repositioning splint was preliminarily established. The designed jaw position was realized on the right and the condyle was more inferior than the designed position on the left. Both displacement of the upper models and absolute difference values of centers showed no significant differences (P>0.05) in different vertical jaw dimensions. The displacement of the upper models was (0.25±0.04) mm. The absolute difference values of centers along the three coordinating axes X, Y, and Z were respectively (0.08±0.01) mm, (0.30±0.02) mm, and (0.21±0.04) mm.@*CONCLUSION@#A novel method of determining the jaw position of repositioning splint with the aid of digital technique is established. It is proved to be feasible by try-in after multi-data fusion, computer-aided design and computer-aided manufacturing. As is shown in vitro, it is accurate to apply this method in adjusting jaw position. Further clinical trial will be designed to evaluate its clinical effect.

Research progress in occlusal splint therapy for temporomandibular joint disorders / 中华口腔医学杂志

Temporomandibular disorders (TMD) is a common clinical disease with complex etiology and diverse treatment. There are many studies on the treatment of TMD. Occlusal splint therapy is the most commonly used TMD treatment solution, but its effectiveness remains unclear. A review of the latest literature is therefore conducted to evaluate the effectiveness of splint therapy for TMD.

Present situation and future of occlusal splint in treatment of oral diseases / 中华口腔医学杂志

Occlusal splint is a removable device for the treatment of oral and maxillary diseases with reversible occlusal treatment property. When patients wear the occlusal splint, the occlusal contact state can be changed and the position of the lower jaw may be adjusted, with the improvement of functions of temporomandibular joints and masticatory muscles. There are various types of occlusal splints, among which stabilization splint, soft occlusal splint and repositioning splint are widely used in the treatment of temporomandibular disorders and night bruxism. For the patients requiring occlusal reconstruction, occlusal splint can be used as an important means to adjust and verify the therapeutic jaw position. As a major trend of research in future, the digital design and production of occlusal splint are still in the initial stage and need to be further improved.

Efeitos de diferentes terapias conservadoras sobre a dor, aspectos psicossociais, relacionados ao sono e à qualidade de vida em indivíduos com disfunção temporomandibular: ensaio clínico randomizado / Effects of different conservative therapies on pain, psychosocial aspects, sleep-related aspects and quality of life in individuals with temporomandibular disorders: randomized clinical trial

A disfunção temporomandibular (DTM) consiste em um conjunto de condições que envolve as articulações temporomandibulares (ATM), os músculos mastigatórios e estruturas associadas. É bastante prevalente no Brasil e no mundo, tem caráter multifatorial e auto limitante, o que proporcionou o desenvolvimento de uma grande variedade de terapias para manejo dos seus principais sinais e sintomas. Esse ensaio clínico randomizado cego avaliou o efeito de terapias conservadoras sobre sintomas físicos, psicológicos, relacionados ao sono e à qualidade de vida em pacientes diagnosticados com DTM e se alterações psicológicas e do sono interferem no controle da dor desses pacientes após as condutas terapêuticas. A amostra foi constituída por 87 indivíduos diagnosticados com DTM pelo Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) randomicamente alocados entre os grupos de tratamento: dispositivo oclusal (DO), aconselhamento (AC), fisioterapia (FT) e DO associado ao AC. Os sintomas de ansiedade foram diagnosticados pelo Índice de Ansiedade Traço-Estado (IDATE), Escala Hospitalar de Ansiedade e Depressão (HADS) e Inventário de Ansiedade de Beck (BAI). Os sintomas de depressão foram avaliados através do HADS e Inventário de Depressão de Beck (BDI). A qualidade subjetiva do sono, qualidade de vida geral e relacionada á saúde bucal, função e intensidade de dor foram investigadas através do Índice de Qualidade do Sono de Pittsburgh (PSQI), Questionário de Qualidade de Vida da Organização Mundial de Saúde - abreviado (WHOQOL), Impacto da Saúde Bucal na Qualidade de Vida (OHIP 14) e Escala Analógica Visual (EVA) respectivamente. As coletas foram realizadas no baseline, com 1 mês e 3 meses após a conclusão das terapias por um investigador cego e treinado. Utilizou-se o teste SPANOVA para a análise do efeito das terapias ao longo do tempo e entre os grupos e os testes de Friedman e Mann Whitney para avaliar os níveis de dor intra e intergrupos em todos os tempos com um nível de significância de 5 %. Observou-se que nenhuma terapia apresentou diferença estatisticamente significante em relação a outra e que todas apresentaram efeitos significativos na melhoria dos índices avaliados (sintomas de ansiedade IDATE p=0,002 ­ HADS p<0,001 ­ BAI p<0,001, depressão BDI p=0,001, qualidade subjetiva do sono PSQI p=0,005, qualidade de vida geral WHOQOL p=0,029 e relacionada a saúde bucal OHIP p <0,001 e índice de dor p<0,001) ao longo do tempo, exceto para o HADS depressão p=0,106. Verificou-se que todos os pacientes com sintomas alterados reduziram significativamente seus níveis de dor após as terapias (HADS p<0,001; BAI p<0,001; BDI p<0,001; PSQI p=0,010), mas que os pacientes ansiosos (BAI p=0,021) tiveram uma redução estatisticamente significativa maior (delta=2,84) quando comparados aos indivíduos normais (delta=1,10) e igualmente a qualidade do sono (QS) alterada (p=0,006). Conclui-se que todas as terapias conservadoras geraram resultados positivos em relação a sintomas físicos, psicológicos, relacionados ao sono e à qualidade de vida e que não houve elementos para afirmar que os tratamentos não foram iguais. E ainda que a presença de sintomas de ansiedade e depressão e QS ruim apresentaram maiores níveis de dor no baseline, porém esses fatores não influenciaram negativamente na melhora após as terapias conservadoras com DO, AC, FT, DO+AC para DTM e que ansiedade e sono alterado podem até gerar um efeito maior nesta redução (AU).

Temporomandibular Disorder (TMD) consists of a set of conditions that involve the temporomandibular joints (TMJ), masticatory muscles and associated structures. It is very prevalent in Brazil and worldwide, has a multifactorial and self-limiting character, which has allowed the development of a great variety of therapies to manage its main signs and symptoms. This blinded randomized clinical trial evaluated the physical, functional, psychological, sleep-related and quality of life symptoms in patients diagnosed with TMD after different therapies: occlusal splint (OS), counseling (C), manual therapy (TM) and associated OS to C and if psychological and sleep disturbances interfere in the pain control of these patients after the therapeutic conducts. The sample consisted of 87 individuals diagnosed with TMD by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) randomly assigned between the treatment groups. Anxiety symptoms were diagnosed by the Trait-State Anxiety Index (IDATE), Hospital Anxiety and Depression Scale (HADS), and Beck Anxiety Inventory (BAI). Symptoms of depression were assessed using the HADS and Beck Depression Inventory (BDI). The subjective quality of sleep, general quality of life and related to oral health, function and intensity of pain were investigated through the Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life Questionnaire - bref (WHOQOL ), Oral Health Impact Profile (OHIP 14) and Visual Analogue Scale (VAS), respectively. The assessments were performed at the baseline, 1 month and 3 months after completion of the therapies by a blind and trained investigator. The SPANOVA test was used to analyze the effect of therapies over time and between groups with a confidence level of 95% and Friedman and Mann Whitney tests to assess intra- and intergroup pain levels at all times with a significance level of 5%. It was observed that no therapy had a statistically significant difference in relation to the other, and that all had significant effects on the improvement of the indexes evaluated (anxiety IDATE p=0.002 ­ HADS p<0.001 ­ BAI p<0.001 and depression BDI p=0.001 symptoms, subjective sleep quality PSQI p=0.005, general quality of life WHOQOL p=0.029, oral health related quality of life OHIP p <0.001 and pain intensity p<0.001) over time, except for the HADS depression (p = 0.106). It was found that all patients with altered symptoms significantly reduced their pain levels after the therapies (HADS p <0.001; BAI p <0.001; BDI p <0.001; PSQI p = 0.010), but that anxious patients (BAI p = 0.021) had a statistically significant greater reduction (delta = 2.84) when compared to normal individuals (delta = 1.10) and also the altered QS (p = 0.006). It was concluded that all conservative therapies generated positive outcomes regarding physical, psychological, sleep-related and quality of life symptoms and there were no elements to state that the treatments were not equal. And although anxious, depressed patients with low QS had higher levels of pain in the baseline and these factors did not negatively influence their reduction after DO, AC, FT, DO + AC and TMD therapies, and that anxiety and altered sleep may even have a greater effect on this reduction (AU).

Placas protectoras de mucosa: su aplicación estomatológica / Occlusal splints for mucosal protection

El objetivo de esta comunicación es divulgar el uso de las placas de protectoras de mucosa (PPM) en el ámbito de la patología bucal, así como en la consulta odontológica diaria. Tomando como antecedente los primitivos protectores bucales diseñados para deportes de contacto, se desarrolló su uso en odontología con un diseño particular para el tratamiento de los desórdenes temporomandibulares. Describimos aquí la aplicación de las PPM en estomatología en el contexto de coadyuvancia terapéutica para diferentes entidades de muy frecuente consulta. Asimismo, se detallan la técnica de confección y las indicaciones de uso y cuidado para los pacientes (AU)

The aim of this report is to emphasize the usefulness of oral splints for mucosa protection in oral pathology as well as in every day dental practice. There is substantial evidence that mouthguards were first developed for use in boxing. The most common therapeutic use of occlusal splints in dentistry is the treatment of temporomandibular joint disorders. The present work describes the use of oral splints for mucosa protection in the context of adjuvant therapy as a protective device for many common disorders of the oral mucosa. At the same time it explains the fabrication technique and provides proper use and handling guidelines (AU)

Occlusal splints pretreatment for long-term complete denture wearers: A systematic review / Pré-tratamento com placas oclusais para usuários de prótese total durante longos períodos. Uma revisão sistemática

The aim of this systematic review was to answer the focused question: "Would the use of occlusal splints be beneficial prior to the rehabilitation of long-term complete denture wearers?" Eletronic searches were performed until November 2016 in MedLine (PubMed), ISI Web of Science, Scopus, Scielo, Lilacs, Ibecs and the Cochrane Library. As eligibility criteria, any prospective or retrospective clinical trials that evaluated the use of occlusal splints in long-term complete denture wearers was selected. It was evaluated the extent of mandibular movements, pain symptomatology, intra-articular space, vertical dimension, and muscle activity. A total of 1152 potentially relevant records were identified from all databases. After title and abstract examination, 577 studies were excluded. Only 4 studies fulfilled all the selection criteria. All studies were longitudinal, and the period using the occlusal splints ranged from 30 to 360 days. Electromyography was the main evaluation method used, but pain scales and electrognathography were also used in two studies. There is scientific evidence supporting that occlusal splints pretreatment should be considered for patients whose long- term denture wearing experience is associated with compromised mandibular movements and vertical dimension of occlusion.

O objetivo desta revisão sistemática foi responder à questão: "Seria benéfico o uso de placas oclusais antes da reabilitação de usuários de próteses totais durante longo período?". Foram realizadas buscas nas bases eletrônicas MedLine (PubMed), ISI Web de Ciência, Scopus, Scielo, Lilacs, Ibecs e a Cochrane Library até novembro de 2016. Incluíam-se nos critérios de elegibilidade qualquer ensaio clínico prospectivo ou retrospectivo avaliando o uso de placas oclusais em usuários de prótese total durante longos períodos. Foi avaliada a extensão dos movimentos mandibulares, sintomatologia da dor, espaço intra-articular, dimensão vertical e atividade muscular. Um total de 1152 registros potencialmente relevantes foram identificados nos bancos de dados. Após a leitura do título e resumo, 577 estudos foram excluídos. Apenas 4 estudos preencheram todos os critérios de inclusão. Todos os estudos incluídos eram longitudinais, e o período em que usavam as placas oclusais variou de 30 a 360 dias. A eletromiografia foi o principal método de avaliação utilizado, mas as escalas de dor e a eletrognatografia também foram utilizadas em dois estudos. Há evidências científicas para suportar o uso de placas oclusais como pré-tratamento de pacientes que apresentam movimentos mandibulares e a dimensão vertical de oclusão comprometidos devido ao uso de próteses totais durante longos períodos.

Utility of facebow in the fabrication of complete dentures, occlusal splints and full arch fixed dental prostheses: A systematic review

The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis. Materials and Methods: A systematic review protocol was registered at PROSPERO registry, University of York, UK (CRD42016041919). Following databases were explored: PubMed, CINAHL, Cochrane, and Web of knowledge. The PICO model included participants who received occlusal splint or complete denture or full arch fixed dental prosthesis at the centric relation position. The intervention was the use of facebow transfer. Comparators were prosthesis made without using a facebow. Outcomes were the patient satisfaction of the prosthesis and the need for laboratory adjustments. Only randomized clinical trials were included in the present review. A customized data extraction pro forma was used to extract the data and assess its quality. Results: A total of 505 articles were retrieved. On excluding duplicates, protocols, case reports, case series, narrative reviews, etc., only eight studies were selected for review. Six clinical trials on 249 complete dentures and two clinical trials on 65 occlusal splints were reviewed. No study on full arch crown and bridge work satisfied the inclusion criteria. Conclusions: The use of facebow did not yield a superior fit or comfort of the complete dentures or occlusal splints. Therefore, there is no evidence of the utility facebow transfer for these prostheses. However, no inference could be drawn for its utility in full arch fixed dental prosthesis as there were no studies to draw an inference.

Bone remodeling in patients with juvenile condylar resorption after stabilization splint treatment / 中华口腔医学杂志

Objective@#To investigate bone remodeling in patients with different types of juvenile condylar resorption after stabilization splint treatment using cone-beam CT (CBCT).@*Methods@#Fifty-nine juvenile condylar resorption patients (114 sides of condyle) treated with stabilization splint from January 2012 to May 2018 in Department of Temporomandibular Joint, Stomatological Hospital of Chongqing Medical University were selected as splint group, while twenty-four patients (48 sides of condyle) who underwent natural remodeling without stabilization splint treatment after 6-12 months were severed as control group. Pre-and post-treatment CBCT was taken for all patients. There were three types of condyles (including type Ⅰ, type Ⅱ and type Ⅲ) before treatment and four types of condyles (including progression, no changes, stable without new bone and remodeled with new bone) after treatment. Progression and no change were considered as poor curative effect, and stable without new bone and remodeled with new bone were considered to be effective. The vertical distance of the condylar height was measured and compared before and after treatment in the two groups.@*Results@#Significant difference in treatment outcome was found in types Ⅰ and Ⅱ between the splint group and the control group (Z=-2.874, P=0.004; Z=-3.874, P=0.000), and no significant difference was found in type Ⅲ between the two groups (Z=-0.617, P=0.537). The difference of condylar progression percentage [splint group: 43% (15/35), control group: 80% (16/20)] was statistically significant between the two groups in type Ⅱ (χ2=7.139, P=0.011), and no significant difference was found in types Ⅰ and Ⅲ between the two groups (χ2=0.103, P=0.748; χ2=1.249, P=0.540). In two groups, the condylar height difference before and after treatment in type Ⅱ condylar resorption was statistically significant (P<0.05).@*Conclusions@#Stabilization splint treatment was effective in patients with different types of juvenile condylar resorption, especially in type Ⅰ. However, it was difficult to reverse the height reduction of the condylar bone regardless of treatment.