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Influence of stabilization occlusal splints on sternocleidomastoid and masseter electromyographic activity.

The present work was conducted in order to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in subjects with tenderness to palpation in these muscles. A full-arch maxillary stabilization occlusal splint was made for each of 14 subjects. Tonic EMG activity, as well as during saliva swallowing and maximal voluntary clenching, was recorded with and without a stabilization occlusal splint inserted. Similar tonic, as well as maximal voluntary clenching EMG activity, with and without the stabilization occlusal splint, was observed. During saliva swallowing, the activity in both muscles was significantly lower with the stabilization occlusal splint. This suggests that daytime use of the stabilization occlusal splint might improve tenderness to palpation in the studied muscles, since the frequency of swallowing function is higher during waking hours.

Adult↗

[Effects of the occlusal splint on stress distribution of the mandible with temporomandibular joint disorders].

OBJECTIVE: To investigate the biomechanical mechanism of occlusal splint therapy of temporomandibular joint disorders (TMD). METHODS: The changes of stress distribution on the mandible with TMD before and after occlusal splint therapy were simulated and analyzed by three-dimensional finite element method. RESULTS: Occlusal splint influenced the character of stress distribution on the mandible. It might distinctly decrease maximum and minimum principal stresses on each region of the mandible with TMD, among which the stress on condylar surface of ill side was reduced more significantly, and the stress distribution of bilateral condyles was close to equality and balance. Meanwhile, the stress symmetry on every position of the mandible was improved slightly. CONCLUSIONS: Occlusal splint can alleviate even eliminate the injury to the temporomandibular joint, and make unbalance of joint inner environment adjusted and restored by improving the stress distribution. This is primarily thought to be one of the main biomechanical mechanism of occlusal splint treatment.

Biomechanical Phenomena↗

Influence of an occlusal splint on integrated electromyography of the masseter muscles.

In order to examine the effect of an occlusal splint on the integrated electromyography (EMG) of the masticatory muscles, EMG of bilateral masseter muscles of 23 patients with temporomandibular joint disturbance syndrome (TMJDS), with and without an occlusal splint, was measured and integrated on line during maximum clenching. It was found that the integrated myoelectrical value of the masseter muscle on the involved and non-involved side was reduced with the occlusal splint. The absolute difference between integrated myoelectrical values in the left and right masseter muscles was reduced with an occlusal splint, but the relative difference remained virtually unchanged. These results indicate that the occlusal splint can decrease masseter muscle activity and thus exert a therapeutic effect.

Adult↗

Evaluation of acupuncture and occlusal splint therapy in the treatment of temporomandibular joint disorders.

One hundred patients showed signs and symptoms of temporomandibular joint disorder, were participated in a one year follow up study. The patients were randomly divided into four groups: Acuhealth treatment (group A), occlusal splint therapy (group B), Acuhealth and occlusal splint therapy (group C), and control (group D). Each group comprised 25 patients. The patients were examined before and 3, 6, and 12 months after treatment. At the three month evaluation, the patients who were not satisfied with the treatment outcome were offered additional treatment. The result showed that 87% of the patients treated by Acuhealth unit, 77.3% of the patients treated with occlusal splint therapy, and 91.3% of the patients received Acuhealth and occlusal splint therapy were improved subjectively and clinically after 3 months follow-up. The patients who responded well to treatment initially also responded well in the long run. The study showed that the Acuhealth unit proved to be an ideal early therapy for TMD, and complemented later with occlusal splint.

Acupuncture Points↗

Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: comparison with a flat occlusal splint and an untreated control group.

The anterior repositioning splint is widely used to treat temporomandibular joints with reciprocal clicking. This treatment was compared to a flat occlusal splint and to an untreated control group. The anterior repositioning splint decreased joint pain at rest, during chewing, and during protrusion. Reciprocal clicking was eliminated and palpatory tenderness of the joint and muscles was reduced. This favorable effect was of short duration. The majority of the patients reported pain and clicking and demonstrated tenderness following removal of the splint after 6 weeks' treatment. The flat occlusal splint decreased joint tenderness but did not affect clicking or muscle tenderness. In the control group the clicking remained and the frequency of muscle tenderness increased. The results indicate that temporomandibular joints with reciprocal clicking can be successfully treated by positioning the mandible anteriorly. Since the symptoms returned when the splint was removed a more permanent change of mandibular position seems necessary.

Adolescent↗

Influence of stabilization occlusal splint on craniocervical relationships. Part I: Cephalometric analysis.

This study was conducted in order to determine the effect of an occlusal splint on craniocervical relationships, in subjects with muscle spasms in the sternocleidomastoid and trapezius muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. Two lateral craniocervical radiographs were taken for each subject, with and without an occlusal splint. Cephalometric analysis showed that the splint caused a significant extension of the head on the cervical spine. There was also a significant decrease in the cervical spine lordosis in the first, second and third cervical segment. These cervical changes could be a compensation mechanism caused by the extension of the cranium on the upper cervical spine. The change in the curvature implies that it is necessary to periodically evaluate the changes occurring in the craniocervical relationships after the occlusal splint has been inserted.

Adult↗

Evaluation of occlusal splint therapy and relaxation procedures in patients with temporomandibular disorders.

Twenty-four patients were selected to participate in this study. Twelve patients were randomly selected to receive occlusal splint therapy and the other 12 to receive a simplified relaxation therapy technique. Observable pain scores, maximum comfortable interincisal distance, and maximum interincisal distances were recorded for each group before and after treatment. The occlusal splint group showed a significant decrease in total mean observable pain scores (decrease score of 10.5, t = 3.124; P less than 0.1). The relaxation group showed no significant decrease in total mean observable pain scores (decrease score of 1.8, t = 0.888; P = ns). The occlusal splint group showed a significant increase in the mean maximum comfortable opening (an increase of 12.4 mm, t = 5.085; P less than .01). The relaxation group showed no significant increase in the mean maximum comfortable opening (an increase of 2.3 mm, t = 0.734; P = ns). The occlusal splint group showed a significant increase in the mean maximum opening (an increase of 6.0 mm, t = 2.471; P less than .05). The relaxation group showed no increase in the mean maximum opening (decrease of 0.7 mm, t = 0.343; P = ns). This study suggests that occlusal splint therapy is a more effective treatment for the pain, tenderness, and limited mandibular opening associated with temporomandibular disorders than relaxation therapy. In this study, the relaxation technique used had no significant effect on the patients' pain, tenderness, or limited opening.

Adult↗

The effects of an occlusal splint on the electromyographic activities of the temporal and masseter muscles during maximal clenching in patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders.

The effects of a full arch maxillary plane occlusal splint on the level of electromyographic (EMG) activity in the anterior temporal and masseter muscles during maximal clenching were studied in 31 patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders, before and after occlusal splint therapy. The results showed, before treatment, that the occlusal splint changed significantly (in 71% of patients) the level of EMG activity during maximal clenching. However, these changes were not consistent and differed between patients and even, in some patients, between muscles. After long-term occlusal splint therapy and improvement of the signs and symptoms of craniomandibular disorders, the number of patients who had an identical level of EMG activity during maximal clenching in the intercuspal position and on the occlusal splint tended to increase. Moreover, in these patients the level of symmetry of action in pairs of muscles during maximal clenching was strong, and the splint did not change this level of symmetry.

Adolescent↗

[Application of occlusal splint for the patient with temporomandibular joint dysfunction. An application of silane coupling treatment: a case report].

The bite plane therapy has been one of the most useful treatment methods for patients with temporomandibular joint (TMJ) dysfunction. But the bite plane usually causes esthetic and articulation disturbances and it is occasionally difficult to use during mastication. The authors have fabricated a new type of bite plane, named occlusal splints, which covers each side of the premolars and molars. The occlusal splint was constructed by a hard-resin for the occlusal part and cast clasps for the retentive part and these parts were adhered after a pre-treatment of metal by the use of a silane coupling agent (Silicoater system). The patient was a 35 year-old man, with a chief complaint of left side reciprocal TMJ clicking. The anterior repositioning type of bite plane was applied for the treatment with the diagnosis of anterior disk displacement with reduction. But he complained of esthetic and articulation disturbances especially during working and eating. After four months we fabricated an occlusal splint that can be used for a long period of time. The patient was satisfied to use this occlusal splint and no symptoms of TMJ dysfunction were found with this appliance. It is suggested that the occlusal splint consisting of a hard-resin and cast clasps is a useful appliance especially for the purpose of use during working and eating, and for evaluating the properness of mandibular position.

Adult↗

Direct-indirect heat-cured occlusal splint fabrication for a patient with limited mouth opening.

There are several conditions that can cause limited mouth opening. Recent literature on some of the most common conditions is discussed in this article. The difficulty in making alginate impressions may prevent indirect laboratory fabrication of heat-cured occlusal splints for patients with limited mouth opening. This article presents a combined direct-indirect technique for fabricating a heat-cured laboratory-processed maxillary occlusal splint in a case where making a mandibular alginate impression would have been extremely difficult. An extra-hard baseplate wax interocclusal record was used as a template for occlusal splint fabrication. The wax record was fitted to the maxillary side, then the mandible was gently manipulated to provide light imprints of the opposing teeth. The wax record provided the therapeutic vertical dimension as well as the therapeutic interocclusal relationship for the occlusal splint. The wax record was seated and sealed to the maxillary cast and modified on the palatal and facial aspects for the appropriate splint shape. The splint was processed using clear heat-cured acrylic resin. It required minimum adjustment on delivery. This procedure spared the patient from having a lower impression, which would have been required for the traditional laboratory-made occlusal splint. Increased adjustment time and excessive exposure to unoccurred acrylic resin, which would have occurred with direct intraoral fabrication, were minimized or eliminated using this technique.

Acrylic Resins↗

Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Part I. A comparative study.

One hundred and ten patients, 23 males and 87 females, participated in a comparative study of the effect of acupuncture and occlusal splint therapy. All the patients exhibited signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than six months. The participants were randomly assigned to three groups; acupuncture treatment, occlusal splint therapy or control. The patients were evaluated before and immediately after treatment/control time. Ten different subjective and/or clinical assessment variables were used in the evaluation of the treatment effects. Both acupuncture and occlusal splint therapy reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged. In this short-term study, acupuncture gave better subjective results (p < 0.001) than the occlusal splint therapy.

Acetaminophen↗

Influence of stabilization occlusal splint on craniocervical relationships. Part II: Electromyographic analysis.

The aim of this study was to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and trapezius muscles in subjects with spasm in the mentioned muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. In the sternocleidomastoid muscle, tonic and saliva swallowing EMG activity decreased significantly with the splint, whereas maximal clenching activity did not change. In the trapezius muscle, no significant changes were observed with the occlusal splint. The different pattern in both muscles during tonic and swallowing EMG activity with the splint is attributed to differences in the synaptic inputs to the respective motoneuron pools, suggesting that a differential modulation of the motor neuron pools may exist of both muscles, of peripheral and/or central origin.

Adult↗

Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment.

Sixty-three patients with an arthrographic diagnosis of disk displacement with reduction were randomly assigned to three treatment groups: (I) onlays to maintain disk repositioning, (II) flat occlusal splint, or (III) untreated controls. Guidance for construction of the disk-repositioning onlays was established during arthrography to obtain a recaptured disk position relative to the condyle. The onlays were cemented to the teeth and maintained the new intercuspal position anteriorly and inferiorly. The flat occlusal splint was used at night only and was adjusted to maintain a maximal occlusal contact in centric relation and centric occlusion. Clinical examinations were performed before and after 6 months of treatment. The disk-repositioning onlays improved joint function and reduced joint and muscle pain when compared with the flat occlusal splint and with nontreatment. The signs and symptoms in the flat occlusal splint group were no different from those in the control group. It is concluded that disk-repositioning onlays are effective in reducing pain and dysfunction associated with disk displacement with reduction in patients in whom the disk can be maintained in a normal relationship to the condyle with the aid of such onlays. The symptoms, however, returned when the onlays were removed after 6 months; this raises the question of whether a permanent change in the intercuspal position is necessary for long-term success.

Adolescent↗

Salivary flow rates during relaxing, clenching, and chewing-like movement with maxillary occlusal splints.

The purpose of this study was to test the hypothesis that the application of occlusal splints increases the diurnal salivary flow rate both in bruxism patients and in normal subjects. Salivary flow rates in 16 adult volunteers (8 bruxism patients and 8 sex- and age-matched control subjects) were measured with the spitting method. There was no significant difference in the salivary flow rate with or without splints between the control and bruxism groups. In all subjects, the salivary flow rates with splints were significantly higher than those without splints during relaxing, clenching, and chewing-like movement. The salivary flow rate during the chewing-like movement was significantly higher than that during relaxing and clenching, irrespective of splint application. The results suggest that maxillary occlusal splints might stimulate salivary secretion, particularly during chewing-like movement, in both bruxism patients and normal subjects.

Adult↗

An easily fabricated occlusal splint.

An easy and inexpensive method for fabrication of an occlusal splint has been described. It has a high degree of patient acceptance and is effective in treating TMJ dysfunction symptoms. If a hard acrylic occlusal splint is preferred, the aforementioned method can be used as an interim appliance until necessary appointments can be scheduled.

Dental Occlusion↗

The effect of the occlusal splints on the treatment of temporomandibular disorders--a computerized electromyographic study of masseter and anterior temporalis muscles.

The effect of the occlusal splints on the treatment of temporomandibular disorders--a computerized electromyographic study of masseter and anterior temporalis muscles. The comprehension of the determinant factors of temporomandibular disorders is still inconclusive, since that the etiology is associated with multidisciplinary knowledge. The purpose of this study was to evaluate the effectiveness of the therapy with occlusal splints in patients with temporomandibular disorders by the computerized electromyography. It was selected twenty-two patients with signs and symptoms with changes of the stomatognathic system, males and females patients, with ages between 18 and 53 years old. Plane occlusal surface splints were constructed in acrylic resin and placed in each patients. Electromyographic evaluations of masseter and anterior temporalis muscles were performed during the mandibular isometric clenching before inserting and after 90, 120 and 150 days of using the occlusal splints. After 90 and 120 days of using them, they were changed by canine guidance and group function respectively. The results after the polynomial regression analysis showed that there were significant reductions (p < 0.05) in the electromyographic activity along the entire period of treatment during the mandibular isometric clenching for masseter and anterior temporalis muscles. The group function showed a shorter eletromyographic activity for both muscles.

Adolescent↗

A modified occlusal splint to avoid tracheotomy for total midface osteotomies.

A modified occlusal splint is described which may be used to avoid tracheostomy when a total midface osteotomy is required. We demonstrate the accuracy of the modified splint by using the technique in a control subject who underwent alginate impressions, dental casts, and a face-bow transfer. A modified splint was constructed on the articulated dental models and was found to be accurate within the range of rotational movement of the temporomandibular joint. The technique is demonstrated in a patient with Crouzon's syndrome undergoing cranial vault reshaping and a monobloc (midface) advancement. The modified occlusal splint provides an alternative method of airway management when precise intraoperative occlusal relationships are important.

Child↗

Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. II. A 1-year follow-up study.

Eighty patients, of whom 22 were men and 58 women, participated in a 1-year follow-up study. All participants in the study showed signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than 6 months at treatment start. The patients were randomly assigned to either acupuncture or occlusal splint therapy. Those patients who did not respond to either of the treatment modes were offered various additional therapies. The result showed that 57% of the patients who received acupuncture and 68% of the patients treated with occlusal splint therapy benefited subjectively (p < 0.01) and clinically (p < 0.001) from the treatment over a 12-month period. No statistically significant difference was found between the two groups as to the assessment variables. Those patients who received various additional therapies after acupuncture and/or occlusal splint therapy responded favorably to additional treatment in only a few instances. The study showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year follow-up period.

Activities of Daily Living↗