A critical evaluation of orthopedic interocclusal appliance therapy: effectiveness for specific symptoms

This paper reviews the effectiveness of occlusal splints on specific symptoms that are often associated with TM disorders. The research has shown the clicking TMJ is sometimes helped but not cured by the traditional stabilization interocclusal appliance and that TMJ clicking is the least responsive to treatment. Questions have been raised about the need to specifically treat the clicking joint; more research on this issue is necessary. Painful TMJs have been shown to respond to occlusal appliance therapy, but questions still exist about the effectiveness of interocclusal appliances for this symptom. There is little scientific proof available about the ability of splints to effectively slow down or reverse degenerative TMJ changes that are evident on radiographs. Masticatory muscle pain is by far the symptom that has the best experimental evidence to support occlusal splints as a highly effective method of treatment. These changes are probably mediated via an alteration in the patient's muscle activity patterns. Those patients with more severe symptoms are less likely to be helped with splints as a sole treatment modality. The effect of occlusal appliances in muscle trismus has been discussed but not effectively evaluated in the literature. Occlusal splints have been shown to have a distinct influence on improving mandibular muscle coordination. Inter-occlusal splints are a commonly used method of controlling attrition and adverse tooth loading, and few questions have been raised in the literature about this therapeutic application.     

The precision of computer-generated surgical splints.

PURPOSE: The purpose of this study was to assess the precision of stereolithographic surgical splints generated by the authors' computer-aided design and manufacturing (CAD/CAM) technique by comparing them with the conventional acrylic splints. MATERIALS AND METHODS: Seven volunteers were used. A pair of surgical splints, stereolithographic and conventional acrylic splints, was fabricated for each subject. A novel method was developed to quantify the airspace between the teeth and the splint. Conventional acrylic surgical splints served as a control group. The airspaces were recorded by impression materials and sliced cross-sectionally. Corresponding areas of the cross-sectional airspaces between stereolithographic and acrylic splints were measured and compared. Pearson's correlation coefficient and linear regression tests were performed. RESULTS: Seven pairs of surgical splints were created. The areas of 98 pairs of cross-sectional airspaces were measured. The average difference between the conventional and the STL splints was 0.24 +/- 0.23 mm(2). The correlation coefficient (r) of the airspace areas between the stereolithographic and conventional acrylic splints was 1.00, and the regression coefficient (beta) was 1.03 (P <.01). CONCLUSIONS: The results indicated that the stereolithographic splints, generated by the authors' CAD/CAM technique, had a high degree of accuracy. The fit of the STL splints was the same as the conventional surgical splints. In the future, traditional plaster dental model surgery will be replaced by computer-assisted surgical planning. The surgical splints will be made in the computer and the treatment plan will be directly transferred to the patient.     

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.     

Universal polycarbonate fracture splint and its direct bonding potential

A polycarbonate splint has been presented which offers the advantage of the ability of being bonded and/or wired into place. This new type of splint offers several advantages over traditional steel splints. The splint can be bonded and/or wired to the dental arch; the bonding method can be a time-saver. The polycarbonate material is readily malleable and does not possess an intrinsic tension or spring usually found in plastics when they are bent or shaped. The splint is highly esthetic when compared to steel splints. Polycarbonate splints are more economical than steel splints. Molded plastic surfaces are smoother and are more compatible with the oral mucosal than the stamped steel surfaces. Finally, and most importantly, the patient acceptance of polycarbonate splints appears to be very good in comparison with steel splints. The above advantages seem to indicate that the future acceptance of this type of splint for maxillofacial injuries will be good, although, it should be understood that plastic splints are not as strong as steel splints and may occasionally break after several weeks of use. Breakage, however, may not cause the splint to become unusable and usually does not occur until after the 4th week of use, if at all.     

Occlusal splints and temporomandibular disorders: why, when, how?

Occlusal splints are one form of treatment in the management of patients with a temporomandibular disorder. Appliances are often used in conjunction with other forms of treatment such as physiotherapy or medication. A variety of splints is described in the literature and the dentist must ensure that the splint prescribed is of a design that has a proven success rate for the specific diagnosis. General principles that apply to the provision of all splints are outlined in this paper.     

Preimpregnated, fiber-reinforced prostheses. Part II. Direct applications: splints and fixed partial dentures.

This article is the second in a series that describes the development, physical properties, and clinical applications of fiber-reinforced composite materials. The development of fiber-reinforced composite technology has opened new avenues for fabricating direct tooth replacements and splints that are esthetic and simple in design and execution and have the potential for excellent durability. Splinting techniques for hypermobile dentitions or postorthodontic retention and the replacement of anterior and posterior teeth using a groove preparation, a denture tooth, and a fiber-reinforced composite framework will be described.     

The physiology of splint therapy: a literature review

The clinician must frequently make treatment decisions with limited knowledge of the appropriateness and consequences of the different options. Patients have specific expectations: that the treatment they receive is the usual one, that they have been informed of the alternatives and the consequences, and most importantly that the treatment has a reasonable chance of success. In TMJ therapy, as with most treatments, the patient's improvement is closely connected to a proper diagnosis based on sound physiologic principles. This investigation will review four basic splint types and discuss their success in the resolution of various temporomandibular disorders. Since the position of the condyle-disc-fossa, the occlusal contact pattern and the masticatory muscle dynamics are interrelated, this study will focus on the physiologic changes splints may cause with modification of this tooth, joint and muscle relationship. Hopefully, selection of a specific splint design appropriate to the patient's disorder will be facilitated by better understanding of its physiologic and therapeutic effects.     

A systematic review on the effects of occlusal splint therapy on muscle strength

ABSTRACT

Objective: The aim of this study was to conduct a systematic review on the effectiveness of occlusal splints for improving muscle strength. Occlusal splints are oral appliances that cause joint stabilization.

Methods: A mix of medical and sports science terms was used to perform the search on several databases (Web of Science, Science Direct, SPORT Discus, PubMed, and Springer).

Results: Twelve studies were reviewed, and their analysis indicates a trend pointing toward a limited interaction between the use of occlusal splints and improved muscle strength.

Discussion: The extent of occlusal splints’ impact on muscle strength is presently unknown. At this stage, there is no general agreement as to whether occlusal splints can be used as ergogenic aids. The number of studies on this specific topic and their different experimental designs precludes drawing more definite conclusions. Further research is warranted to elucidate possible changes resulting from occlusal splints during exercise.     

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。     

Recording the trajectory of mouth opening and closing for the fabrication of an occlusal splint

Various attempts have been made to transfer the transverse hinge axis and mandibular movement pattern to the mechanical articulator and to fabricate dental prostheses with the fewest errors. However, the occlusal adjustment of a dental prosthesis is always necessary to ensure a precise intraoral fit even when the facebow transfer technique is used in the cast mounting procedure. This is because the true hinge axis is not obtained when the facebow is applied to a patient who exhibits a variable mandible movement pattern rather than a single rotational axis. This technique merges facial scanning data and digital data obtained from a diagnostic cast based on measurements of several landmarks of the anterior teeth and makes it possible to design a dental prosthesis while considering the mandibular opening and closing movements of the patient. This technique could be used to design prosthetic restorations, occlusal splints, and intermediate splints for orthognathic surgery and for complete mouth rehabilitation when changes in vertical dimensions are needed.     

Using soft splints in your dental practice

A significant number of soft splints are fabricated by U.S. dentists every year. The efficacy of these splints is discussed, reported indications and contraindications are defined, and favorable and unfavorable characteristics reported by patients are presented. Maxillary and mandibular soft splint designs that have been found to be clinically acceptable are illustrated and an easy and rapid technique for adjusting and polishing a soft splint is proposed.     

Application of principles of evidence-based medicine to occlusal treatment for temporomandibular disorders: are there lessons to be learned?

Critical evaluation of treatment methods has become an important part of health care and will certainly have a major influence on decisions about acceptable treatment methods in the future. Evidence-based medicine (EBM) means the systematic, explicit, and judicious implementation of the best evidence in patient care. The most reliable sources of evidence are high-quality systematic reviews and randomized controlled trials (RCTs). A systematic EBM approach could be particularly useful in the treatment of temporomandibular disorders (TMD), where controversial and conflicting ideas about management are common. In this field, concerns about the lack of evidence are often expressed. This article aims to elucidate and discuss the application of EBM to the treatment of TMD, using the most controversial treatments (i.e., occlusal treatments) as an example. By applying the principles of EBM to TMD treatments, we wish to highlight some of the important issues that form the basis for high-quality care in this field. A systematic review of occlusal treatments (occlusal splints and occlusal adjustment) updated to January 2003 revealed 16 RCTs of occlusal splints and 4 of occlusal adjustment. The overall quality of the trials was fairly low. Recently, however, some high-quality RCTs of occlusal splints have been published. The most obvious methodologic shortcomings in published trials included problems in defining the patient population, inadequacies in performing randomization and blinding, problems in defining the therapies or appropriate control treatments, short follow-ups, and problems in monitoring patient compliance. Occlusal splint studies yielded equivocal results. Even in the most studied area, stabilization splints for myofascial face pain, the results do not justify definite conclusions about the efficacy of splint therapy. Their clinical effectiveness to relieve pain also seems modest when compared with pain treatment methods in general. None of the occlusal adjustment studies provided evidence supporting the use of this treatment method. The clinical implications of the findings and future perspectives are discussed.     

The use and fabrication of a self-retaining surgical guide for controlled implant placement: a technical note.

A technique for using a surgical guide construction with a self-retaining feature, which has proven to be a significant improvement for stage 1 surgical procedures, is described. This design is more convenient to use than previously described occlusal extension splints. It maintains the concepts for ideal fixture placement that have proven so valuable in creating both a functionally and esthetically uncompromised prosthesis supported by implants.     

Craniofacial characteristics of successful responders to mandibular advancement splint therapy: a pilot study

Cephalometric variables that can be used to identify patients with obstructive sleep apnoea who are suitable for mandibular advancement splints and surgical maxillomandibular advancement are lacking. The aim of this pilot study was to describe the craniofacial characteristics of patients whose symptoms of obstructive sleep apnoea were successfully treated with mandibular advancement splints and who were subsequently considered for maxillomandibular advancement. We retrospectively compared the craniofacial characteristics of our patients with data from 2 previously published studies. There were significant differences between the 2 groups for ANB (p < 0.000), overjet (p < 0.0001), Go–Me (p < 0.0002), and ANS–PNS (p < 0.0009). Patients, whose symptoms improve with the use of mandibular advancement splints and are potential candidates for maxillomandibular advancement, may have unique craniofacial features consisting of bimaxillary retrusion characterised by a shorter maxilla and mandible, and a greater class II skeletal tendency. The results of this study should be viewed as a pilot. Further research is required.     

Technical and clinical assessment of the use of a new material-based splint in orthognathic surgery

Heat or auto-cured acrylic resins are materials that are commonly used in splint construction. Newly developed light-cured resins hold promise in view of the altered characteristics of the material. The aim of this study was to evaluate how far light-curing resin-based splints can be used in orthognathic surgery. Over a period of 1 year, 141 orthognathic surgeries were planned and performed using randomly chosen light-cured splints versus auto-polymerized splints. The performance of splint fabrication, the model planning and the clinical use were assessed by different measurements. The dental technician, the orthodontist and the surgeon evaluated objective parameters (model damage, fabrication time, accuracy of registration, adjustment time) as well as subjective criteria (handling). This study revealed that the use of light-curing splints significantly improved the accuracy (97.7% versus 81.2% in the case of acrylic materials). Less time was needed for the fabrication and adjustment of the splint. There was concomitantly less model damage to be observed when light-curing resins were used (9.2% versus 83.5%) and subjective measurements revealed significantly better handling of light-curing resin-based splints. Light-curing resin splints used in orthognathic surgery seem to be advantageous.     

Intranasal prostheses, splints, and stents

Internal defects of the nose result from congenital abnormalities, trauma, tumor excision, and complications of cosmetic or airway enhancement procedures. Since the nose is a prominent feature of the face, and nasal deformities present complicated reconstructive problems, the rehabilitation of this structure assumes great importance. Surgical and/or prosthetic procedures using intranasal prostheses, splints, or stents have been developed to improve both form and function. Intranasal prostheses, splints, and stents during nasal rehabilitation can (1) establish and maintain airway patency, (2) maintain tissue position, (3) reduce tissue contracture after surgery, or (4) support mobile tissue in the construction and retention of facial prostheses. Although techniques for managing common problems have been presented in this article, unique clinical situations will arise. Much of the execution and ultimate success of nasal prosthetics will depend upon the ingenuity of the dentist performing the service.     

A comparative study of the fit and retention of interocclusal splints constructed from heat-cured and autopolymerized polymethylmethacrylate.

Fifty-three subjects each had a single Michigan splint constructed of either heat-cured or autopolymerized polymethylmethacrylate. The choice of material was decided randomly. A blind assessment for fit and retention was used on a three-point scale. Fit and retention were apparently unaffected by the material used. Thirteen percent of splints were unsatisfactory for clinical use (poor fit or retention) and this was also independent of material. A small number of splints contained structural faults (voids, porosity, or cracks) that may shorten the clinical life of these restorations; 9 of 12 such faults occurred in the autopolymerized group. Previous research has shown that conventional heat-cured polymethyl-methacrylate has superior properties compared with autopolymerized resin. In the absence of differences in accuracy of fit or retention, a heat-cured material is therefore advised where splints are intended for long-term clinical use.     

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.     

The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model

Although current guidelines for the treatment of traumatic injuries recommend the use of 'flexible' splints, the precise definition of what is considered flexible versus rigid has not been rigorously defined, leaving the clinician with a wide range of options for this critical factor. The purpose of this study was to quantify and compare the effect of eight different splints on tooth mobility after extraction and replantation using a human cadaveric model. Following strict selection criteria including complete root maturation, lack of periodontal disease, normal bone levels, and crown integrity, a maxillary central incisor was atraumatically extracted and splinted with eight different splints. The experimental splints included a 30-pound test monofilament nylon-composite splint and six wire-composite splints made of wires of 0.012' (0.3 mm), 0.016' (0.4 mm), or 0.020' (0.5 mm) diameter stainless steel (SS) or nickel titanium (NT). A direct composite splint represented the most rigid type of splint. These eight splints were applied five times each, and tooth mobility was measured before and after each splint was applied. The average splint effect, defined as the difference between the presplint and the postsplint measurements quantified using the Periotest, was calculated for each splint and compared. No significant differences were found between the nylon-composite and the wire-composite splints. There was significantly less tooth mobility with the direct composite splint compared to all other splints. In conclusion, the results of this study suggest that nylon and SS or NT wires up to 0.016' diameter are significantly more flexible than direct composite splints and thus may be better suited for the splinting and management of traumatized teeth.     

Does the use of soft or hard splints affect the short-term outcome of temporomandibular joint arthrocentesis?

Arthrocentesis is an effective treatment modality for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR), especially in patients who do not respond to non-surgical methods, and is nowadays regarded as a first-line treatment. Soft and hard stabilizing splints have also been used to treat TMJ disorders, but no data are available regarding the use of splints following arthrocentesis. The aim of this study was to compare the effect of the use of soft or hard stabilizing splints versus no appliance following TMJ arthrocentesis on the prognosis of the treatment. Forty-five patients with DDw/oR were included in the study. Pain was measured on a visual analog scale, and maximal mouth openings, lateral jaw movements and tenderness were recorded before arthrocentesis. Following arthrocentesis hard splints were fabricated for 22 patients, soft splints for 9 patients, and 14 patients without any splint served as controls. All the measurements were repeated 1 day, 1 month, 3 months and 6 months after arthrocentesis. Improvement in mouth opening was significant as well as decrease in pain in all groups regardless of the use of splints (P<0.05). Arthrocentesis alone is a successful procedure in the treatment of DDw/oR; the use of splints as an additional therapy does not affect the short-term prognosis.