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The use of transcranial stimulation in the fabrication of an occlusal splint.

An alternative method for fabricating occlusal splints by means of electric transcortical stimulation is presented. Ensuing results in one patient suggest neuromuscular benefits. However, the centric occlusal position determined by this method is a painful procedure because of electric stimulation on the scalp. Further and extensive investigations must be carried out to assess the clinical benefits and limits of this method.

Dental Occlusion↗

An evaluation of a polyvinyl occlusal splint for improving the health of inflamed maxillary supporting mucosa of complete denture patients.

A study was made to determine the effects of a polyvinyl occlusal splint on improving the health of inflamed maxillary supporting mucosa. Color slides were made before and after treatment of the maxillary supporting mucosa of 22 edentulous patients wearing dentures during a 15-day test period. The control group consisted of 13 patients, and the experimental group was comprised of nine patients who wore the occlusal splint over the maxillary denture. The 35 mm color slides taken before and after treatment were evaluated by 50 examiners to determine if the health of the maxillary supporting mucosa was better, the same, or worse after the 15-day test period. Fourteen of the examiners were retested to determine the reliability of the viewer. An observable change was noted in the experimental group at a p value less than 1 in 100,000. These findings indicate that the occlusal splint was effective in improving the health status in 64.7% of the experimental patients and that the experimental method was valid.

Dental Occlusion↗

Restoration of canine guidance on an occlusal splint using amalgam: a clinical report.

A primary consequence of sleep bruxism is severe tooth wear. Although an occlusal splint is able to protect teeth, grinding may continue on its surface. This clinical report describes an approach to restore canine guidance on an occlusal splint, with amalgam, for a patient with sleep bruxism. This procedure allowed maintenance of the canine guidance for a period of time longer than 3 months, postponing the fabrication of a new splint.

Adolescent↗

Occlusal splint fabrication.

There are many methods of fabricating an occlusal splint. The advantages of the technique described are as follows: (1) little intraoral adjustment is required, (2) there is ease in construction, and (3) only one set of diagnostic casts can serve for both occlusal analysis and splint construction. The disadvantage is that an occlusion with group function cannot be produced by this method.

Acrylic Resins↗

Dimensional stability of occlusal splints.

Five fabrication techniques and two storage methods were used to construct and store specimens to investigate the dimensional stability of acrylic resin occlusal splints. A research model was developed to more closely approximate the tooth coverage limits of occlusal splints. Ten specimens were fabricated on individual stone casts for each of the five techniques. Four die pins were transferred to each specimen, and the distances between the inside diameters of the pins were measured over a 2-week period. After construction, initial measurement, and removal from the cast, each acrylic resin specimen was stored in either a wet or a dry environment. Measurements between pins were made and recorded at five time intervals. The sprinkle-on techniques resulted in less dimensional change than the dough application, the vacuum-adapted resin sheet and dough application, and the heat-cured denture processing techniques. Acrylic resin specimens stored in a wet environment showed less distortion 2 weeks after fabrication.

Acrylic Resins↗

Effect of canine guidance of maxillary occlusal splint on level of activation of masticatory muscles.

The effect of canine guidance of a full-arch maxillary flat occlusal splint on the level of activation of the anterior and posterior, temporal, masseter and suprahyoid muscles during maximal clenching, were studied in 14 subjects without craniomandibular disorders. The results revealed that, the level of electromyographic activity of anterior and posterior temporal and suprahyoid muscles during maximal clenching on the occlusal splint in habitual closure was unchanged, as compared to biting in the intercuspal position (ICP), while the activity in the masseter muscle, on average, was increased slightly (13 percent). In contrast, the level of activation of the jaw elevator muscles decreased significantly during maximal clenching on the cuspid ramp of the splint, as compared to the biting in ICP or clenching on the splint. However, the degree of reduction of activity was not symmetrical, and was most pronounced in the masseter muscle of the biting side and in the anterior and posterior temporal muscles of the non-biting side. No significant difference was observed in the activity of the suprahyoid muscles.

Adult↗

Postural and maximum activity in elevators during mandible pre- and post-occlusal splint treatment of temporomandibular joint disturbance syndrome.

Electromyograms (EMGs) of the temporal and masseter muscles in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty controls were recorded and integrated on-line in the postural position and during maximum clenching, before and after occlusal splint therapy. Contrasting with the controls, the myoelectrical activity of the patients was higher in the postural position and lower during maximum clenching, whilst the former in percentage terms increased when compared to the latter. After treatment, the EMG indexes in some patients returned partially, and in others completely, to a normal level. Tenderness in the mandibular elevators, deviated opening and organic change in the TMJ increased the postural myoelectrical activity, in percentage terms, against that of maximum clenching. The myoelectrical activity of the mandibular elevators in the postural position and during maximum clenching was smaller in patients with the occlusal splint than in those without. The results show that the mandibular elevators in the patients with TMJDS were hyperactive and tense, and that the occlusal splint was useful for treating such dysfunction.

Adult↗

[Biomechanically optimized construction of occlusal splints and subjective evaluation by probands].

In a double blind study twelve class I probands received occlusal splints with six different customized anterior guidances. The subjective feelings were rated using a psychologic scale. It was shown, that splints with a large "a" were better rated than splints with a small "a". "a" is the radius of the maximal curvature of the sagittal anterior tooth curvature. The transition between positive and negative ratings was very sharp and localized at the individual "a". These results suggest that occlusal splints can be optimized by including customized anterior guidances. A detailed technical description of the manufacturing of these splints is given.

Consumer Behavior↗

Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy.

The present study assessed condylar displacement between initial maximal habitual intercuspation (MHI) and centric relation (CR), recorded after using a deprogramming occlusal splint for an average period of 7.8 +/- 2.1 months prior to any orthodontic treatment. The sample consisted of 22 subjects, 11 male and 11 female, with an average age of 14.2 +/- 1.4 years, with Class II malocclusion and with no apparent signs or symptoms of temporomandibular dysfunction (TMD). Condylar displacement was measured using a Panadent axis position indicator in decimal fractions of a millimeter. The original mean vertical displacements and the corresponding standard deviations were 4.24 +/- 2.53 mm and 3.86 +/- 2.72 mm, respectively, for the right and left sides. Because a significant negative correlation was observed between original condylar displacements and age factors, the displacement values were statistically adjusted to 2.74 +/- 2.00 mm and 2.44 +/- 1.93 mm. On the horizontal plane, the mean displacements measured were -0.72 +/- 1.53 mm on the right side and -0.51 +/- 1.98 mm on the left. The mean displacement on the transversal plane was 0.03 +/- 0.87 mm. A comparison between these values and those observed in non-deprogrammed groups, as well as those published in the related literature, indicates that use of occlusal splints results in greater mean condylar displacement values, especially vertically, between CR and MHI positions, which contributed to a more accurate orthodontic diagnosis.

Adolescent↗

Therapeutic effects of the plane occlusal splint on signs and symptoms of craniomandibular disorders in patients with nocturnal bruxism.

The long-term effects were studied of a full arch maxillary plane occlusal splint on chronic signs and symptoms of craniomandibular disorders (CMD) in 31 patients with nocturnal bruxism. The results revealed that the score and intensity of signs and symptoms in this type of patient fluctuate from day to day and even within a single day. In spite of continuation of nocturnal bruxism, the symptoms of CMD were cured or improved with the long-term use of the occlusal splint. However, in general, the symptoms recurred after discontinuation of splint therapy. The therapeutic mechanisms of the splint during sleep are discussed.

Adolescent↗

A case series of temporomandibular disorders treated with acupuncture, occlusal splint and point injection therapy.

A treatment regime combining acupuncture, occlusal splint and point injection therapy for temporomandibular disorders (TMD) is presented. There were 89 consecutive patients treated by the regime in this case series but four patients dropped out after two to three visits. Data and treatment results of the remaining 85 patients who had treatment completed were analysed. It was found that 73 (85%) of patients with TMD had symptoms relieved within six visits under this regime. Complications were rare and minor. Acupuncture treatment, in combination with splint therapy and point injection therapy, appears to be effective for managing TMD. However, further research, using randomised controlled trials should be conducted to ascertain its effectiveness over other treatment modalities.

Acupuncture Points↗

Fitting acrylic occlusal splints and an experimental laminated appliance used in migraine prevention therapy.

OBJECTIVE: To evaluate clinical procedures and chair time required to seat and adjust hard, heat-cured acrylic occlusal splints and an alternative laminated appliance developed to simplify construction of migraine prevention appliances. DESIGN AND SETTING: Single-centre study in the Oral Medicine Clinic, The Royal Hospitals, Belfast, Northern Ireland. METHOD: Questionnaires were distributed, January-May 2003, to operators fitting occlusal splints for 100 consecutive patients selected for migraine prevention therapy. Half the appliances were made in heat-polymerised acrylic with the remainder using a novel combination of ethylene vinyl acetate and light-curing urethane dimethacrylate. Information on operator experience, the nature of any fitting surface and occlusal adjustments together with an estimate of the time taken to make alterations was recorded. KEY FINDINGS: The need for adjustment to seat appliances intraorally was significantly less for migraine prevention appliances made using an experimental laminating technique. Where modifications were necessary, there was no significant difference in the chair time required to fit either the heat-cured hard or experimental laminated migraine prevention appliance. CONCLUSION: Provision of migraine prevention appliances may be more time efficient if the dental practitioner considers a laminated approach to construction.

Acrylic Resins↗

A short-term evaluation of the effectiveness of stabilization-type occlusal splint therapy for specific symptoms of temporomandibular joint dysfunction syndrome.

To clarify the short-term effectiveness of stabilization-type occlusal splint therapy, a specific symptom approach was used toward 30 temporomandibular joint dysfunction patients with more than two major symptoms (temporomandibular joint and/or masticatory muscle pain, temporomandibular joint sounds, and limitation of mandibular movement). Eighty-seven percent of the patients with pain responded with this therapy and more than 50% had complete relief of pain 4 weeks after insertion of the splint. Temporomandibular joint sounds and limitation of mandibular movement responded more slowly than pain. These results suggest that the stabilization-type occlusal splint should be selected as a first choice among several therapies and that temporomandibular joint pain is particularly susceptible to this therapy.

Acrylic Resins↗

Soft occlusal splint therapy in the treatment of migraine and other headaches.

Fifty-seven patients suffering from migraine, tension headache or tension vascular headache were prescribed a soft occlusal splint for night-time wear. Dental, psychosocial/psychiatric and neurological data were recorded prior to commencement of therapy and at the conclusion of a 3 month treatment period. A statistically significant number of patients presenting with migraine or tension vascular headache experienced marked improvement or complete relief of headache symptoms, but most patients suffering from tension headache failed to benefit from splint therapy. A majority of patients displaying intercurrent features of craniomandibular dysfunction experienced reduction in these symptoms also. There was a statistically significant association between TMJ improvement and headache type. Prior to treatment, patients who subsequently benefited from splint therapy in terms of headache improvement had experienced significantly fewer headaches than patients who failed to respond, although headache intensity and duration were similar in both groups. It is suggested that headache type and frequency may be prognostic indicators of the likely success of dental splint therapy in treatment of headache. Nevertheless, the use of occlusal splints in the treatment of patients complaining of headache in the absence of evidence of craniomandibular dysfunction should not be embarked upon until medical examination has excluded the possibility of organic neurological disorder.

Adolescent↗

Occlusion in temporomandibular disorders: treatment after occlusal splint therapy.

The concept of using the condylar path as the reference for occlusion is questionable for the patient whose temporomandibular joint has pathological changes because the condylar path of TMD patient deviates greatly. After occlusal splint therapy it is suggested that the patient's occlusion be treated using the Twin-Stage Procedure which does not require measurement of the condylar path. The research findings that occlusion controls the condylar path seems to support the concept that if the dentist creates the occlusion properly, the condylar path may be corrected and thereby minimise the micro-trauma which causes TMD.

Dental Articulators↗

Nocturnal electromyographic evaluation of myofascial pain dysfunction in patients undergoing occlusal splint therapy.

Twenty-five patients with symptoms of myofascial pain and abnormal jaw function were treated with use of a full arch maxillary occlusal splint. The level of nocturnal activity of the masseter muscle was monitored as were symptoms before, during, and after occlusal splint therapy. A decreased nocturnal EMG level during treatment was noted for 52% of the patients. A return to pretreatment EMG levels after removal of the splint was noticed in 92% of the patients; in 28% no change was shown and in 20%, an increase was shown in nocturnal EMG levels. The splint was most likely to reduce nocturnal EMG levels in patients with least severe symptoms.

Adult↗

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↗

Effect of occlusal splint and transcutaneous electric nerve stimulation on the signs and symptoms of temporomandibular disorders in patients with bruxism.

A crossed-design experimental study has been made involving simple blind paired data and random assignment to treatment, with the aim of evaluating the action of an occlusal splint with transcutaneous electric nerve stimulation (TENS) upon the manifestations of temporomandibular disorders (TMD) in patients with bruxism. The prevalence of TMD in the 24 patients with bruxism was 62.5%%; the corresponding severity, as determined by the pantographic reproducibility index (PRI), was mild (mean value: 20.71). Clicking and pain in the lateral pterygoid muscle were the most frequent clinical manifestations. The occlusal splint and TENS did not significantly improve the signs and symptoms of TMD in these patients with bruxism.

Adult↗