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PubMed1988

The effect of interdental continuous loop wire splinting and intermaxillary fixation on the marginal gingiva.

To study the influence of interdental loop-wire splinting and intermaxillary fixation on the marginal gingiva, 30 patients were evaluated clinically using different periodontal parameters, at 5 examination times. It was shown that despite a standardized oral hygiene regime including the use of a mouthrinse, gingival inflammation occurred for the duration of the splinting period. Factors other than the presence of limited plaque, such as gingival trauma due to splint application and subsequent mechanical irritation should be considered as possible aetiological factors. All investigated marginal gingival changes had totally reversed 2 weeks following loop-wire splint removal, apart from tooth mobility which did not re-attain pre-operative levels, the difference, however, being statistically insignificant.

Bone Wires↗

PubMed1994

Development of a tetraplegic hand assessment and splinting protocol.

The occupational therapists at the National Spinal Injuries Centre initiated a survey of national and international spinal units in order to investigate which components of hand assessment and which hand splints were most commonly used on patients who have had a spinal cord injury. One hundred and seven questionnaires were sent, but of the 49 returned, only 44 of the assessment questionnaires and 46 of the splinting questionnaires were fully completed and could be used for this study. The results from this survey, the information gathered from the literature and the experiences of the occupational therapists, were used to develop a tetraplegic hand assessment and splinting protocol. This protocol has helped the occupational therapists to be more thorough in their hand assessments, and more discerning with the splints that they make or supply for patients. The low response would suggest that this study should be viewed as a pilot one and that there is need for more valid and reliable research.

Hand↗

PubMed2004

Treatment of temporomandibular disorders by stabilising splints in general dental practice: results after initial treatment.

INTRODUCTION: Little is known about how effective general dental practitioners (GDPs) are in treating temporomandibular disorders (TMD). The overall aim of this study was to compare the lower stabilising splint (SS) with a non-occluding control (CS) for the management of TMD in general dental practice. METHOD: A total of 93 TMD patients attending 11 GDPs were randomly allocated to SS or CS. Diagnosis was according to International Headache Society Criteria. Outcome criteria included pain visual analogue scale (VAS), number of tender muscles, aggregate joint tenderness, inter-incisal opening, TMJ clicks and headaches. Splints were fitted one week after baseline and patients were followed-up every three weeks to three months; those not responding to CS after six weeks (< 50% VAS reduction) were crossed over to SS for a further three months. RESULTS: Documentation was returned from nine GDPs for 72 patients (38 for SS, 34 for CS). At six weeks, mean improvements were noted for all outcome criteria, but less so for clicking. There were no significant differences between splints [chi(2)]. Seventeen CS patients had < 50% VAS reduction and were provided with SS in the cross-over group. CS patients with >50% VAS reduction were significantly younger than CS patients who crossed-over (ANOVA, p=0.009) and had significantly less diagnoses of TMJ clicking (chi(2), p<0.05). At the conclusion of the trial 16 patients were referred for specialist management: 11 non-responders (< 50% VAS reduction), one of whom needed occlusal adjustment and five responders also needing occlusal adjustment. CONCLUSIONS: At six weeks SS gave similar relief to CS for all outcome criteria. Patients who crossed-over from CS to SS were more likely to be older and have clicking TMJs. At the end of treatment nine of 11 non-responders to SS had a diagnosis of disc displacement with reduction. However, 80% TMD patients were managed effectively by GDPs using splints for periods of up to five months.

Adult↗

PubMed2005

The effect of a mandibular advancement splint in subjects with sleep-related breathing disorders.

OBJECTIVE: This study assessed the effectiveness of a mandibular advancement splint (MAS) in subjects with sleep-related breathing disorders using both objective and subjective outcome measures. DESIGN: The study was carried out as a retrospective analysis. SETTING: The study was conducted within the Sleep Studies Unit at the Queen Victoria Hospital, East Grinstead, between May 1997 and March 2000. SUBJECTS AND METHODS: Twenty subjects with obstructive sleep apnoea (OSA) and six with non-apnoeic snoring, diagnosed by overnight polysomnography, were fitted with a monobloc appliance between May 1997 and March 2000. MAIN OUTCOME MEASURES: The subjects were analysed for changes in the respiratory disturbance index (RDI) and Epworth Sleepiness Scale (ESS) scores. In addition each subject completed an outcome questionnaire following fitting of the appliance. RESULTS: Variability in response measured by the change in the respiratory disturbance index was found with no correlation to the baseline recording. Although median RDI values improved in both groups, significantly so in the obstructive sleep apnoea group (p<0.05), seven subjects exhibited an increased RDI score following mandibular advancement splint therapy. The median Epworth Sleepiness Scale scores decreased in both the OSA group and the non-apnoeic snorers although not significantly. Twenty-one of the 26 subjects completed the outcome questionnaire revealing an 81% reduction in snoring. Side-effects were generally transient and minor. Eighty-six per cent of the subjects' partners reported better quality of sleep as a result of MAS therapy. CONCLUSIONS: The monobloc appliance significantly improved the Respiratory Disturbance Index in the obstructive sleep apnoea group. Some subjects had increased RDI scores following splint therapy. This supports the need for an objective assessment in the follow-up of patients treated with mandibular advancement splints.

Adult↗

PubMed2001

Maintenance of condylar position using an occlusal splint after mechanical vibrating-traction of the TMJ.

Although adequate relief of excess mechanical loading to the joint has been accepted as one of the important treatment concepts in the orthopaedic field, a treatment method for the temporomandibular joint (TMJ) to relieve excess mechanical loading has not yet been established. This study aimed to clarify the effect of an occlusal splint on the maintenance of the distracted condylar position achieved by vibrating-traction method. Vibrating dynamic traction force was applied for 5 min to the right TMJ using vibrating-traction apparatus. A flat stabilization splint was adjusted to keep the mandibular position and the condylar displacement was evaluated for 6 h after the dynamic traction procedure. Mean vertical displacement of the mandibular right first molar immediately after the vibrating-traction for the six subjects was 156 microm (ranging from 141 to 179 microm). The calculated mean condylar displacement immediately after the traction was 480 mum and could be kept to be 381 mum even after 6 h by wearing the flat stabilization splint. From the results of this study, it was revealed that the mechanically tracted condylar position could be maintained by a flat occlusal splint. It was suggested that the vibrating-traction method followed by the provision of occlusal support might have a possibility to work as a mechanical relieving procedure for the TMJ.

Adult↗

PubMed2003

[Splints in occupational therapy of the hand in an Austrian central hospital--current status].

Ergotherapeutic splinting is essential in the treatment of diseases, injuries and innate deformities of the hand. However due to its high material and staff costs, a definitely diagnosed indication is a prequisite for prescription. A retrospective study was performed using the Krankenhausinformationssystem (KIS) to establish the total number of hand splints prescribed by the Department of Physical Medicine and Rehabilitation of the General Hospital of Vienna from 1/1992 until 8/1998, as well as referring doctors/departments and diagnoses leading to referral were recorded and descriptively evaluated. The total number of patients was 1972. 1236 (63%) of the cases were referred by surgical departments/branches, 410 (20%) by internal departments, 151 (8%) by the neurological department and 175 (9%) by other departments. The diagnosis leading to referral were rheumatoid arthropathies (542 = 26%), peripheral nerve lesions (458 = 22%), tendon lesions (201 = 10%), Dupuytren' contractures after surgery (184 = 8%), degenerative joint diseases (82 = 4%), conditions after fractures (55 = 2.5%), patients after amputations (50 = 2.3%), disorders of the central nervous system (53 = 2.5%), focus removals (40 = 2%) and tendovagintis (35 = 1.7%). The remaining 19% were referred due to surgical repositionings, soft tissue injuries, local infections and various other diagnoses. The majority of ergotherapeutic splintings was prescribed due to forms of rheumatic or rheumatoid diseases, peripheral nerve lesions as well as hand surgery. In this study documenting the clinical practice of a medical center was primarily aimed at providing the basis for further discussion of both factual and economic aspects of future developments in splinting.

Academic Medical Centers↗

PubMed2001

Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols.

The present study was completed to establish an epidemiologic database defining the prehospital occurrence of midthigh trauma/suspected femoral shaft fractures, and the use of/need for traction splints (TS) in hope of developing recommendations for further treatment protocols. On review of 4,513 paramedic run reports for the 12-month period from January 1999 through December 1999, from a low-volume urban emergency medical services (EMS) system, 16 persons (0.35% total patients) presented with midthigh injuries. Data collected included patient chief complaint/injury, mechanism of injury, clinical findings, splint application, additional interventions, iatrogenic complications, patient age, and ambulance field time. Paramedics noted injuries suspicious for femoral shaft fractures in 5 patients (31.25% study patients, 0.11% total patients). TSs were applied successfully only twice (12.50% study patients, 0.04% total patients). Fourteen patients (87.50% study patients) were managed with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort. No sequelae as a result of such care occurred. No inappropriate use, point estimate (PE) [(0)/(16) (0.00% to 20.60%)] or unmet need, PE [(0)/(4), 497) (0.00% to 0.08%)] of care was noted. The data presented in this study suggest that given similar EMS system characteristics, prehospital midthigh injuries/suspected femoral shaft fractures occur on an extremely rare basis, and treatment with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort may constitute an acceptable course of care. Including TSs as essential ambulance equipment may be unnecessary.

Adolescent↗

PubMed2003

Splinting the hand in the functional position after brain impairment: a randomized, controlled trial.

OBJECTIVE: To evaluate the effects of 4 weeks of hand splinting on the length of finger and wrist flexor muscles, hand function, and pain in people with acquired brain impairment. DESIGN: Randomized, assessor-blinded trial. SETTING: Rehabilitation center in Australia. PARTICIPANTS: Twenty-eight adults with acquired brain impairment, all within 6 months of the first injury. There was 1 withdrawal. INTERVENTIONS: Subjects in both experimental (n=17) and control (n=11) groups participated in routine therapy-motor training for upper-limb use and upper-limb stretches-5 days a week. The experimental group also wore an immobilizing hand splint in the functional position (10 degrees -30 degrees wrist extension) for a maximum of 12 hours each night for the duration of the 4-week intervention period. MAIN OUTCOME MEASURES: The length of the wrist and extrinsic finger flexor muscles was evaluated by measuring the torque-controlled range of wrist extension with the fingers extended. Functional hand use was evaluated with the Motor Assessment Scale. Pain was evaluated with a visual analog scale. RESULTS: The effects of splinting were statistically nonsignificant and clinically unimportant. At follow-up, estimates of treatment effects slightly favored the control group: range of motion at the wrist favored controls by 2 degrees (95% confidence interval [CI], -7.2 degrees to 3.2 degrees ), function favored controls by 0.2 points (95% CI, -2.7 to 2.3), and pain favored the experimental group by 1cm (95% CI, -4.6 to 2.2). CONCLUSIONS: An overnight splint-wearing regimen with the affected hand in the functional position does not produce clinically beneficial effects in adults with acquired brain impairment.

Aged↗

PubMedDate not supplied

Minimalistic splint design: a rationale told in a personal style.

Theoretic clinical reasoning is becoming increasingly important in splint construction. The purpose of this paper is to present an algorithm of decision steps that will help therapists consider all aspects of splint making proactively, so that they can take the necessary steps to be successful. A decision flowchart is presented and discussed in detail. An extra dimension of splint design is emphasized-namely, frugality in structure, technique, and cost. The paper concludes that the use of a comprehensive decision algorithm provides the basis for successful working technique and that the ability to create minimal-design splints is more a state of mind than a technical skill.

Algorithms↗

PubMed1999

Flexor tendon repair using a stainless steel external splint. Biomechanical study on human cadaver flexor tendons.

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion exercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

Finger Injuries↗

PubMed2001

A common-sense approach to splint therapy.

Splint therapy is a proven modality for alleviating the pain of many types of temporomandibular disorders and bruxism, though questions still remain regarding how splints work. In this article, a review of the literature is used to determine an effective splint design for the different degrees of temporomandibular problems. Sufficient credible literature exists to help provide an understanding of and a treatment protocol for the use of splints for temporomandibular disorders and bruxism problems.

Bruxism↗

PubMed2000

Effect of exercise and nasal splinting on static and dynamic measures of nasal airflow.

The main aim of this study was to assess the separate and combined effects of exercise and nasal splinting on static and dynamic measures of nasal airflow. In a randomized crossover design, 12 healthy participants (6 men, 6 women) performed static and dynamic spirometric nasal airflow assessment tests, with or without nasal splinting (Breathe-Right), before and after a maximal oxygen uptake (VO2max) treadmill test. At least 7 days later, the VO2max, and nasal airflow tests were repeated. The results showed that the measured variables were not significantly different with and without nasal splinting. We conclude that the absence of significantly enhanced nasal patency observed for nasal splinting and after exercise suggest that these factors have a minimal impact on nasal airflow volume and rate.

Adult↗

PubMed2004

The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis.

The aim of the present study was to compare the effect of a new prefabricated Thämert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the splint group. They wore the orthotic devices for 6 weeks. Outcome measures were obtained at baseline and directly after the intervention. These outcome measures were maximal grip strength on the involved side with a pain scale from 1 to 10 to determine the extent of pain during gripping, and the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ). Analysis of variances with repeated measures, a Mann Whitney test and multiple linear regression analysis were used to compare the two groups. Main effect for time was significant for maximal grip strength and sum scores on the PRFEQ, but no differences between groups were found, even when a distinction between acute and chronic symptoms was made. Change in pain score during gripping did not differ significantly between the groups. A multiple linear regression analysis showed that the use of the splint did not significantly contribute to the prediction of change in maximal grip strength and in overall PRFEQ. The conclusion is that the forearm/hand splint is not more effective than the elbow band as a treatment for lateral epicondylitis.

Adult↗

PubMed1978

The value of flexor hinge hand splints.

Functional hand splints have been in use in a number of spinal injury units in the USA since the early 1950s. The splints are designed to provide a pinch-grip either by harnessing wrist dorsiflexion or by external power. Such devices are little used in the United Kingdom. This paper describes the results of late provision of 62 such splints in a Disabled Living Unit. A proportion of tetraplegic patients found such splints of considerable functional value. It is estimated that some 30--60 patients each year would benefit from them if appropriate facilities for early fitting were available.

Adolescent↗

PubMed1995

The effect of occlusal splint therapy on different curve parameters of axiographic TMJ tracings.

Computerized axiography was used as an objective instrumental method of evaluating the response of patients with temporomandibular joint (TMJ) symptomatology to occlusal splint therapy. Diagnosis was performed in a standardized manner by systematically analyzing TMJ path tracings obtained by computerized axiography. Thirty-six patients were axiographed before and after therapy with full-arch occlusal stabilizing appliances, followed by assessing the effect of therapy on various path curve parameters. The data obtained for the patient group treated with splints was compared to that of six patients also axiographed, but left untreated for a period of six weeks before a second TMJ tracing was obtained. The results show that splints have a certain effect on reciprocal TMJ clicking (response rate 67%). Retral stability and path characteristics are also substantially improved (response rates 44% and 40%). Less influence was noted on hypomobile joint paths (response rate 29%), the quality of movements (response rate 28%) and Bennett angle values (response rate 23%). Patients with disk displacements without reduction were not treated with splints, they underwent surgery. Their results will be reported later. By contrast, TMJ tracings in the control group remained essentially unchanged.

Adolescent↗

PubMed1995

Follow-up examination of the temporomandibular joint disk after splint therapy by magnetic resonance imaging--a case report.

A 38-year-old female patient presented with temporomandibular joint (TMJ) pain, bilateral clicking and intermittent locking. The patient was treated with a splint in order to decrease the symptoms and to obtain a proper disk-condyle relationship. The effect of the splint therapy was investigated after one month and after one year and five months using magnetic resonance imaging (MRI) with splints in place. After treatment for one year and six months, the clicking sound of the right TMJ disappeared, and she became free from locking. With the aid of MRI, it was found that the disk of the right TMJ had changed from an anterior position with reduction to a superior position. In the left TMJ, the disk changed from an anterior position without reduction to an anterior position with reduction. MRI gave important information on the disk position and the efficacy of the splint therapy.

Adult↗

PubMed1998

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

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

Adult↗

PubMed2000

Prevalence and patterns of nocturnal bruxofacets on stabilization splints in temporomandibular disorder patients.

The purpose of this study was to investigate the prevalence of nocturnal bruxism, the characteristics of bruxofacets, and the reduction of symptoms in temporomandibular disorder (TMD) patients. The study involved the observation of bruxofacets on a stabilization splint. Twenty-six patients (22 women and 4 men, 16-54 years of age) with signs and symptoms of TMD were given an initial examination before using a splint, and then at intervals of one, three, six and ten weeks after a stabilization splint was first used. In 88% of the patients (n = 23) active shiny facets or scratches caused by nocturnal bruxism appeared on the occlusal surface of splints within ten weeks. In 52% of the 23 patients these facets were created by bilateral mandibular excursions, in 35% by small lateral movements, and in 13% by unilateral excursions. Subjective pain and the Craniomandibular Index in patients had decreased after ten weeks (p < 0.001), but a reduction of symptoms did not differ according to the patterns of the bruxofacets. It was concluded that most TMD patients have a parafunctional habit, namely bruxism. Further research is needed to produce more convincing evidence of a true cause-and-effect relationship between nocturnal bruxism and TMD.

Adolescent↗