Evaluation of occlusal splint therapy in temporomandibular joint disorder patients using real‐time ultrasonography

Aim: The aim of the present study was to evaluate the effect of occlusal splint therapy by determining the cross‐sectional dimension of masseter muscle using ultrasound in patients with temporomandibular joint disc displacement with reduction. Methods: Twenty‐seven patients aged between 20 and 40 years were included in the study. A detailed history was obtained, and a comprehensive clinical examination was carried out. Subjective assessment with structured pro forma was performed pre‐occlusal and post‐occlusal splint therapy. The objective measurement of the bilateral masseter muscle thickness was recorded using real‐time ultrasonography before and after splint therapy. Results: The mean ultrasound thickness of the masseter muscle in the pre‐clenching state before splint therapy was 9.45 mm (SD 1.39), and the post‐clenching state was 13.15 mm (SD 2.23). After splint therapy, the mean thickness in the pre‐clenching state was 9.14 mm (SD 1.31), and the post‐clenching state was 12.78 mm (SD 2.23; P < 0.001). Conclusion: Ultrasonographic measurements of the masseter muscle in patients with temporomandibular joint disc displacement with reduction can be a useful tool to assess the effectiveness of occlusal splint therapy. Such conservative measures can significantly reduce masticatory muscle tenderness, especially of the temporalis and masseter.     

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy‐two patients

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical‐orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups—myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical‐orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.     

咬合板治疗磨牙症的磨牙信息监测研究

目的　应用自行研制的磨牙症监测仪客观评价稳定型咬合板与尖牙高型咬合板治疗磨牙症的临床效果。方法　将 2 0名磨牙症患者随机分为两组 ,在受试条件基本一致的情况下 ,于低于息止颌位 0 5mm的高度分别制作稳定型咬合板与尖牙高型咬合板。应用自行研制的磨牙症监测仪监测每名患者治疗前后的磨牙时间与磨牙次数。结果　尖牙高型咬合板组患者磨牙时间与磨牙次数明显减少 ,治疗前后差异有极显著性 ;稳定型咬合板组患者治疗前后的监测数据差异无显著性。结论　磨牙症监测仪能自动测量和记录戴咬合板的磨牙症患者的磨牙数据 ,有一定的临床应用价值 ;尖牙高型咬合板治疗磨牙症的临床效果明显优于稳定型咬合板。     

真空成形牙合垫和普通塑料牙合垫治疗夜磨牙症的临床效果评价

目的比较真空成形牙合垫与普通塑料牙合垫治疗夜磨牙症的临床效果.方法分别用真空成形术和普通塑料制作牙合垫,嘱患者夜间休息时戴用.结果配戴普通塑料牙合垫和真空成形牙合垫1个月时停止磨牙例数之比为6∶11;6个月时为10∶17,具有显著性差异(P<0.05).结论真空成〗形牙合垫治疗夜磨牙疗效显著,配戴舒适,优于传统塑料牙合垫.     

咬合板的临床应用特点

咬合板是可影响颌位关系的可摘式人工咬合面,又称垫,适用于颞下颌功能紊乱病的诊断和治疗,以及义齿修复过程中咬合位置的确定.咬合板作为可逆性手段,是咬合治疗第一阶段既保守治疗阶段使用的第一步装置.咬合板种类繁多,使用目的 和临床效果不同,临床医师尚缺乏对其临床适应证选择、规范化使用、治疗过程管理等方面的正确认识,也对其临...     

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.     

Evaluation of the effect of a stabilization splint on occlusal force in patients with masticatory muscle disorders

The purpose of this study was to evaluate the effect of stabilization splint therapy on occlusal force in patients with masticatory muscle disorders (MD). Six female patients with myalgia or myofascial pain participated in this study. The occlusal points and load on the dental arch in maximum clenching was measured using the computerized system with Dental Prescale(R) before and after the use of the splint. There were no significant changes in the number of occlusal points, mean occlusal pressure, and asymmetry in occlusal balance between before and after the use of the splint. However, there were significant differences in the extent of the area of occlusion and in the integrated occlusal loads. The integrated occlusal load converged to the normal level with the use of the splint. From the results of this study, it is suggested that the use of the stabilization splint has the effect of normalizing the occlusal force.     

TMD患者咬合板治疗后接触变化的研究

目的:比较咬合板治疗颞下颌关节紊乱病(TMD)前后异常因素的变化情况,探讨咬合板治疗TMD的机理。方法:选取34名用咬合板治疗的TMD患者,记录其戴用咬合板后2个月时的咬合特征及临床症状,并与治疗前进行比较。结果:TMD患者治疗后的力中心距中线距离减小,闭合时间与侧方分离时间明显较治疗前缩短,早接触出现率较治疗前降低,但前伸分离时间、非工作侧干扰及前伸干扰的出现率与治疗前相比无显著性差异。结论:咬合板对于纠正力中心位置、减小早接触的发生率、缩短闭合时间及侧方分离时间具有明显的作用,能够使TMD患者的关系向着更加协调、稳定的方向发展,是其有效治疗TMD的重要机理。     

Influnece 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.     

软塑（牙合）垫治疗夜磨牙症的临床观察

目的观察软塑料（牙合）垫治疗夜磨牙症的效果.方法超硬石膏灌制患者下颌牙列印模,真空热压成形制作下颌软塑料（牙合）垫,2个月后针对磨损点调（牙合）,并统计有效率.结果治疗总有效率为73.5 %,其中,（牙合）垫有磨穿现象的有效率为58.3 %,（牙合）垫无磨穿现象的有效率为77%,结论软（牙合）垫能够有效矫治夜磨牙症,但软塑料（牙合）垫被磨穿者较难纠正夜磨牙症.     

Face‐bow transfer in prosthodontics: a systematic review of the literature

An extensive search for randomised controlled clinical trials was accomplished to compare dental prostheses and occlusal splints constructed with or without face‐bow transfer, and question whether face‐bow transfer may present better clinical results than simpler approaches. Studies were identified by searching electronic databases (PubMed/MEDLINE, Latin American and Caribbean Literature on the Health Science, and Brazilian Bibliography of Dentistry). The keywords ‘dental articulator’, ‘semi‐adjustable articulator’, ‘face‐bow’, ‘jaw relation record’ and ‘occlusal splint therapy’ were used. The minimum inclusion requirements were (i) randomised controlled trials with patients of any age, (ii) comparison between dental prostheses or occlusal splints constructed with or without face‐bow transfer and (iii) assessment of clinician's time, number of occlusal contacts, patient satisfaction or masticatory function. The search resulted in the identification of 8779 articles. Subsequently, 8763 articles were excluded on the basis of title and abstract. By the end of the search phase, eight randomised controlled trials were considered eligible. Current scientific evidence suggests that face‐bow transfer is not imperative to achieve better clinical results in prosthodontics. Randomised clinical trials suggest that simpler approaches for the construction of complete dentures and occlusal splints may present acceptable results, while no clinical study has investigated its use in fixed and removable partial dentures.     

开张式双垫与塑料垫治疗磨牙症的对比研究

目的：比较开张式双垫在治疗磨牙症中与塑料垫的临床疗效。方法：分别用自制的开张式双垫与塑料垫对48位磨牙症患者进行治疗,随访9个月。分别统计治疗结束1个月和9个时的停止磨牙列数和平均减少的磨牙时间。结果：戴用1个月停止磨牙数比为6∶12,戴用9个月停止磨牙数比为10∶21。其差异具有显著性（P〈0.01）。结论：开张式双垫治疗磨牙症优于塑料垫。     

不同方法制作正颌手术数字化[牙合]板的研究及精确性分析

目的探讨不同方法制作正颌手术数字化[牙合]板的流程,并评估其精确性及临床应用价值。方法选择2017年6月—2019年2月就诊于昆明医科大学附属口腔医院口腔颌面外科的牙颌面畸形患者10例为研究对象。分别利用单个软件和多个软件进行术前模拟设计,虚拟截骨,设计数字化[牙合]板,并评估二者精确性和工作时间。同时传统模型外科制作传统[牙合]板,评估单软件数字化[牙合]板的临床运用价值。结果单软件数字化[牙合]板最大拟合误差平均值上颌为(0.0111±0.0038)mm,下颌为(0.0107±0.0037)mm。单软件数字化[牙合]板最大拟合误差优于多软件数字化[牙合]板(P<0.001),各自上下颌面间差异无统计学意义(P>0.05)。[牙合]板术中未出现无法就位情况。无论是单颌还是双颌手术,单软件手术模拟时间均少于多软件手术模拟时间。结论不同方法制作数字化[牙合]板精确性存在差异,单软件数字化[牙合]板精确性优于多软件数字化[牙合]板,模拟耗时更少,具有实际应用价值。     

Making an alternative occlusal splint.

An occlusal splint is commonly used in the diagnosis and management of temporomandibular disorders. In a partially edentulous patient a poorly adapted removable partial denture can prevent the use of a conventional occlusal splint. This article describes the fabrication of an occlusal splint that also incorporates a provisional removable partial denture.     

实验用髁状突纵形骨折保守治疗模型的建立

目的：建立Ｈｅ夹板、颌间固定、Ｈｅ夹板结合颌间固定等保守治疗动物模型,为对比研究髁状从形骨折治疗提供模型。材料与方法：实验用小型猪２４头,分为Ｈｅ夹权治疗６头,颌间固定６头,Ｈｅ夹板结合颌间固定６头正常对照６头,模拟临床使用的上颌稳定性Ｈｅ夹板,在小型猪上设计为铸造金属网状围墙塑料混合垫。颌间固定为左右颌骨间正中Ｈｅ位结扎。结果：Ｈｅ夹板无脱落,塑料啼合面磨损较慢。结论：Ｈｅ夹板等保守治疗模型适合     

A change of occlusal conditions after splint therapy for bruxers with and without pain in the masticatory muscles

Bruxism has been suggested as an initiating or perpetuating factor in a certain subgroup of temporomandibular disorders (TMD), however, the exact association between bruxism and TMD remains unclear. This study aimed to demonstrate the difference in responses between bruxism and a subgroup of TMD to a full-arch maxillary stabilization splint from the standpoint of an occlusal condition. This study was conducted to verify the null hypothesis that there were no differences between bruxer groups with and without myofascial pain (MFP) with respect to the changes in occlusal conditions after the use of a splint. Thirty bruxers with MFP and 30 without MFP participated. Occlusal conditions were examined before and after splint therapy, and occlusal changes following the use of a splint were compared between the two groups. The frequency of occlusal changes after splint therapy was significantly higher in the MFP bruxer group than the non-MFP bruxer group (p < 0.05) for the occlusal conditions investigated in the present study. However, no statistical differences were found with regard to each occlusal condition. This result may show the variety of splint effects and may demonstrate a heterogeneous aspect to bruxism and myofascial pain.     

Fabrication of Easily Reproducible Occlusal Splints

Occlusal splints have been used for many years and for many dental problems. The ability to easily fabricate occlusal splints which are accurate and require a minimum of chair-time is an important consideration.

This article describes a method of occlusal splint fabrication which will produce an occlusal splint that meets the above criteria and also allows for duplicate splints to be easily made. During the process of fabrication, a mold of the splint occlusal form is made which can be used at a later date to reproduce the original splint. This will reduce inconvenience for the patient and reduce the dentist's chair-time.     

Effect of occlusal splints on TMJ symptomatology.

The clinical response of TMJ symptomatology to full-coverage occlusal splints, when used as the only means of treatment, was evaluated. The symptomatology recorded during the last postoperative visit was compared to the initial visit. The response of the different symptoms to the use of the occlusal splint was analyzed statistically using a chi-square test. A statistically significant difference (p = .03) was only found when comparing those groups having only pain or dysfunction symptomatology. The response favored the remission of pain. However, every symptom was improved with the use of an occlusal splint. It was concluded that: 1. Both pain and dysfunction symptomatology will benefit from the occlusal splint therapy. 2. The pain response will be significantly better than the dysfunction response when the patient is treated with an occlusal splint. 3. Eighty percent of the patients suffering from a TMJ syndrome will improve or be cured when the only form of treatment is the use of a full-coverage occlusal splint.     

咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

软性垫和硬性垫治疗夜磨牙或紧咬牙的临床效果观察

目的：观察硬性垫和软性垫治疗夜磨牙或紧咬牙的临床效果。方法对58例夜磨牙或紧咬牙患者随机采用硬性垫或软性垫进行治疗,28例使用硬性垫,30例使用软性垫。患者每天佩戴垫8h以上,睡眠时佩戴,佩戴垫后1个月、2个月、3个月、6个月复诊,问诊并记录肌肉酸痛症状,以及夜磨牙或紧咬牙习惯与佩戴前是否有变化。对佩戴垫6个月时的治疗有效率用SPSS 17.0软件行卡方检验。结果治疗6个月时软性垫和硬性垫的治疗有效率分别为93.33%、82.14%,差异无统计学意义（c2=1.709,P=0.191）。结论硬性垫和软性垫的临床治疗效果均较好,软性垫因制作简便、佩戴舒适,更易被患者接受。