Fabrication Of Occlusal Splints Research Articles

How does artificial aging affect the mechanical properties of occlusal splint materials processed via various technologies?

The mechanical reliability of occlusal splints and their long-term behavior are significant factors determining the clinical outcome of temporomandibular disorder (TMD) therapy. However, improvements are still needed in this area. This in vitro study aimed to (1) compare the hardness and flexural properties of materials manufactured using 3 techniques for occlusal splint fabrication (conventional heat curing, thermoforming followed by light curing, and three-dimensional (3D) printing) and (2) analyze the effect of artificial aging on the properties of the materials. A total of 120 disc-shaped specimens were manufactured for the Shore D hardness evaluation, and 120 bar-shaped specimens were fabricated for the flexural properties evaluation (n = 15 for each group). Each material was tested in 2 groups of specimens, non-aged and artificially aged (stored for 90 days in water at 37°C). Statistical differences were assessed using one-way or two-way parametric analysis of variance (ANOVA) with Tukey's or Šídák's post-hoc test, or the non-parametric KruskalWallis test with Dunn's post-hoc test. A p-value of less than 0.05 was considered statistically significant. The mechanical properties of the materials varied significantly. Among the non-aged materials, the 3D-printed resin exhibited the highest Shore D hardness (85.3D), but it decreased significantly after 90 days of water storage (80.4D, p < 0.0001). The unpolished heat curing acrylic showed the highest resistance to artificial aging (p = 0.0436). However, its hardness decreased significantly after polishing (81.0D vs. 83.4D, p = 0.0015). The conventional heat curing material also exhibited superior flexural properties (σ = 89.63 MPa, E = 2616 MPa). All tested materials were susceptible to deterioration due to aging. The conventional method of occlusal splint fabrication remains the optimal choice, particularly for long-term use. However, it is still necessary to develop materials that are resistant to aging in order to ensure successful clinical performance.

Survival and Success of Dental Implants Placed in a University Setting

Purpose: The aim of this study was to assess the impact of experience and specialty training on the success and survival of dental implant therapy for single-unit fixed restoration of missing teeth in a university setting.&#x0D; Methods: A retrospective study was conducted using data from the electronic patient record system at the Adams School of Dentistry. The Office of Computing and Information Systems provided dental records from January 1, 2013 to December 31, 2018, following the inclusion criteria. The records were manually reviewed by one evaluator (TC). Extracted from the records were subjects’ demographics; medical, dental, and social history; implant parameters; grafting procedures; and timing of placement/restoration/loading. Also recorded were the specialty training and level of experience, i.e., pre-doctoral student, resident, and faculty; the restoration type; radiographic confirmation of osseointegration before restoration; and occlusal splint fabrication. Fisher’s Exact Test was applied to determine if the providers’ specialty training and experience had any statistical significance on implant success and survival.&#x0D; Results: A total of 501 implants were included in the study. Statistically significant were provider training (AEGD versus specialties, implant survival and success), subject’s gender (implant survival), implant type/manufacturer (implant survival and success), and immediate placement (implant survival). The overall survival rate was 97.0% while the success rate was 85.4%.&#x0D; Conclusion: The type of clinical training impacted implant outcome, only when comparing AEGD versus specialties. Operator’s experience has no significance on the results.

Use of occlusal splint in subjects with TMJ disorders by general dental practitioners in Indian scenario

Temporomandibular disorders (TMDs) constitute a global health concern, giving rise to both physical and financial burdens, as evidenced by symptoms and indications indicative of masticatory muscle imbalances. These symptoms encompass manifestations associated with disorders of the masticatory muscles. Scant literature exists regarding the utilization of occlusal splints by general dentists for addressing TMDs within the Indian context. Employing a cross-sectional questionnaire survey, the present study aimed to evaluate the application of occlusal splints in the treatment of temporomandibular issues by Indian dental practitioners. The inquiry involved the administration of a questionnaire designed to investigate the diagnosis, management, and treatment of TMDs by general dentists in India. Responses to the survey questions, provided by 314 general dental practitioners, were subjected to assessment and analysis through statistical methodologies. For practitioners with less than five years of experience, 77.63% (n=118) of participants reported no attendance at Certified Diabetes Educator (CDE) programs, whereas 14.47% (n=22) attended a single CDE session, and 7.89% (n=12) attended multiple CDE sessions related to TMDs. Among those practicing for five to ten years, 57.77% (n=52) did not participate in any TMD-related CDE programs, while 24.4% (n=22) attended one, and 17.7% (n=16) attended more than one. Among practitioners with over ten years of experience, 34.48% (n=20) did not attend any CDE, 24.13% (n=14) attended one, and 37.93% (n=22) attended multiple TMD-related CDE sessions. Diagnosis of TMDs was carried out by 64.33% (n=193) of participants using a combination of study models, imaging, patient history, and medical history. Among a total of 300 subjects, 64.6% (n=194) of participants responded affirmatively to the treatment of patients with TMDs. Hinge and mean value articulators were utilized in conjunction with soft materials for the fabrication of occlusal splints. The survey results suggest a paucity of knowledge among general dental practitioners regarding the application of occlusal splints in the treatment of TMDs.

Evaluation of accuracy of maxillary repositioning surgery using an observer-independent method

ObjectiveTo evaluate the accuracy of maxillary repositioning in two-jaw surgery using computer-aided surgical simulation (CASS) and computer-aided design/manufacturing (CAD/CAM) splints by using a highly accurate observer-independent method. MethodsA retrospective evaluation was conducted of 30 consecutive adults who underwent Le Fort I osteotomy by a single surgeon. Surgical planning and fabrication of occlusal splints were performed using custom-developed CASS software. Preoperative images with landmarks were superimposed on postoperative images to evaluate discrepancies between the planned and actual position of the maxilla following surgery. Translational and rotational differences were expressed as the root mean square deviation (RMSD). The number of cases that exceeded the clinically acceptable limits (2 mm for the translational difference at the centroid, 4° for the rotational difference, and 1 mm for the mediolateral difference at the dental midline) were also evaluated. ResultsPostoperative anteroposterior translation and pitch values were significantly different to and negatively correlated with the planned values, respectively. The largest translational RMSDs at the centroid and the dental midline were 1.04 mm and 1.03 mm, respectively, in the anteroposterior direction. The largest rotational RMSD was 1.86° in pitch. The percentage of discrepancies exceeding the clinically acceptable limit was 3.3% for the centroid, 3.3% for rotation, 20.0% for the midline, and 26.7% for any one criterion. ConclusionWhile maxillary repositioning using CASS and CAD/CAM splints was accurate on a population level, there remains potential for clinically significant errors to occur on an individual level, particularly in controlling the dental midline position and occlusal plane angle.

Tapping the potential of rapid prototyping techniques in creating a paradigm shift in the fabrication of occlusal splints

PurposeThis study aims to cover the overall gamut of rapid prototyping processes and biomaterials used for the fabrication of occlusal splints in a comprehensive manner and elucidate the characteristics of the materials, which are essential in determining their clinical efficacy when exposed to oral surroundings.Design/methodology/approachA collective analysis of published articles covering the use of rapid prototyping technologies in the fabrication of occlusal splints, including manufacturing workflow description and essential properties (mechanical- and thermal-based) evaluation of biocompatible splinting materials, was performed.FindingsWithout advances in rapid prototyping processes and materials engineering, occlusal splints would tend to underperform clinically due to biomechanical limitations.Social implicationsThree-dimensional printing can improve the process capabilities for commercial customization of biomechanically efficient occlusal splints.Originality/valueRapid technological advancement in dentistry with the extensive utilization of rapid prototyping processes, intra-oral scanners and novel biomaterial seems to be the potential breakthrough in the fabrication of customized occlusal splints which have endorsed occlusal splint therapy (OST) as a cornerstone of orthodontic treatment.

A digital workflow in the treatment of patients with temporomandibular joint disorders: a case report

Relevance. TMDs are frequently encountered due to the wide variety and polymorphism of clinical and morphological manifestations.Clinical case description. The clinical example presents an algorithm for clinical and instrumental diagnosis of the dentoalveolar system, the stages of occlusal splint fabrication and clinical monitoring of masticatory muscles, dental occlusion and dentition, based on the application of modern digital technologies for the diagnosis of the dentoalveolar system functional status. The 28-year-old patient underwent a comprehensive diagnosis, including electronic condylography, electromyography, T-scan (digital occlusal analysis), and measurement of condylar displacement from the reference point. A follow-up examination, six weeks after treatment with a mandibular occlusal splint, showed positive changes in the therapeutic process: the absence of occlusal pressure distribution imbalance (T-scan) and symmetric work of masticatory proper and temporal muscles (EMG).

Occlusal splints: the role and fabrication of stabilization splints

Occlusal splints are a useful adjunct in the management of temporomandibular disorders, bruxism and the protection of the natural or restored dentition. Along with a video to accompany the text, this article gives an overview of the role and fabrication of occlusal splints. Indications as well as the clinical and laboratory protocol required for the construction of a full-coverage, hard acrylic splint are covered, along with the current role of CAD/CAM. A video accompanies this article. CPD/Clinical Relevance: The ability to provide a full-coverage, hard acrylic splint will be useful in selected cases.

Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap.

Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models. In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results. Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.

AN INSIGHT INTO THE OCCLUSAL SPLINT THERAPY FOR THE MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

For many years the occlusal splint therapy has been practiced for the diagnosis and treatment of various temporomandibular joint disorders. Many designs have been discussed in the literature. Each of these occlusal appliances are used for specific conditions. A proper examination and diagnosis is essential for selecting the appropriate appliance for that particular situation. This article reviews about the types, designs and materials used for occlusal splint fabrication. The present article also familiarizes the individual application and uses of each occlusal splint.

An overview of applications of PEEK polymer in prosthodontics.

he rapid evolution of computer-aided design and computer-aided manufacturing (CAD-CAM) led to the introduction of newer materials that could be precisely milled for the fabrication of dental prostheses. PEEK (PolyEtherEtherKetone) has been explored for a number of applications for clinical dentistry, including removable dental prostheses, fixed dental prostheses, implant-supported prostheses, resin-bonded fixed dental prostheses and implant-retained overdentures. The major beneficial property of PEEK is its lower Young's modulus, and as elastic as bone, providing a cushioning effect and reduction of stress transferred to abutment teeth. It is a material with high biocompatibility, good mechanical properties, high-temperature resistance, chemical stability, polishability, good wear resistance, and high bond strength with luting cements. Further, PEEK is also recommended for a wide range of CAD-CAM fabricated fixed and removable prostheses, fabrication of occlusal splints, intra-radicular posts, implant abutments and provisional restorations. PEEK material shows a property of radiolucency, which is advantageous for the evaluation of both osseointegrationand tissue surrounding the implant on computed tomography. Considering these properties, PEEK is increasingly being used in implantology.

Adjustment of Occlusal Splint with Synchronized T-Scan III Digital Occlusal Analysis System and Bio-EMG III in a Patient with Sleep Bruxism

The occlusal splint has been frequently used as an effective treatment in sleep bruxism patients. In the adjustment procedure of occlusal splint with an optimal occlusion, clinicians usually use conventional methods; however, they cannot measure the surface area of contacts, amount of force, and contacting time sequence. Recently, two separate technologies have been synchronized together: T-Scan III and BioEMG III. In the present case report, an occlusal splint in a patient with sleep bruxism was adjusted with synchronized T-Scan computerized digital occlusal analysis system and BioEMG III. Optimal occlusal parameters were generated, and quantitative analyses of occlusal scheme and muscle activity level were performed before and after the adjustment of the occlusal splint. In the present case report, occlusion of the occlusal splint in a bruxism patient was adjusted with T-Scan III to fulfill the requirement of the optimal occlusion criteria. Before adjustment of occlusal splint, digital evaluation revealed unbalanced force distribution, lengthy occlusion (1.51 s), and disocclusion time (0.09 s) in centric relation. EMG activity of muscles was lower than expected values in centric relation. After adjustment of occlusal splint, canine protected occlusion with appropriate occlusion (0.2 s) and disocclusion (0.4 s) time were performed. Increased electromyography activity of the right anterior temporalis muscle showed a decrease in all excursive movements. Modern occlusal adjustment procedures provide a new standard of verification for the validation of occlusal splint fabrication with optimal occlusion.

Utility of facebow in the fabrication of complete dentures, occlusal splints and full arch fixed dental prostheses: A systematic review.

The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis. A systematic review protocol was registered at PROSPERO registry, University of York, UK (CRD42016041919). Following databases were explored: PubMed, CINAHL, Cochrane, and Web of knowledge. The PICO model included participants who received occlusal splint or complete denture or full arch fixed dental prosthesis at the centric relation position. The intervention was the use of facebow transfer. Comparators were prosthesis made without using a facebow. Outcomes were the patient satisfaction of the prosthesis and the need for laboratory adjustments. Only randomized clinical trials were included in the present review. A customized data extraction pro forma was used to extract the data and assess its quality. A total of 505 articles were retrieved. On excluding duplicates, protocols, case reports, case series, narrative reviews, etc., only eight studies were selected for review. Six clinical trials on 249 complete dentures and two clinical trials on 65 occlusal splints were reviewed. No study on full arch crown and bridge work satisfied the inclusion criteria. The use of facebow did not yield a superior fit or comfort of the complete dentures or occlusal splints. Therefore, there is no evidence of the utility facebow transfer for these prostheses. However, no inference could be drawn for its utility in full arch fixed dental prosthesis as there were no studies to draw an inference.

CAD/CAM occlusal splint fabrication after implant prosthetic treatment in patients with bruxism

CAD/CAM occlusal splint fabrication after implant prosthetic treatment in patients with bruxism

A pilot study on spatial changes in the maxilla caused by osteopathic therapy.

A variety of theories on the pathogenesis of temporomandibular disorders (TMD) exists resulting in treatment approaches ranging from the fabrication of occlusal splints to alternative treatment modalities such as osteopathy. The goal of this pilot study was to investigate whether osteopathic treatment causes spatial changes in the maxilla. Following ethics commission approval and informed patient consent, three patients diagnosed with TMD participated in this investigation. In addition to regular treatment, an individualized mandibular occlusal splint was fabricated and a maxillary silicone impression was made. Following osteopathic treatment, the splint was adapted intraorally and another maxillary impression was made. Before and after treatment, the splint and the impressions were scanned three-dimensionally. The resulting images were superimposed using best-fit matching algorithms. Inconsistent spatial changes in the posterior areas were observed both in the maxillary impressions as well as in the mandibular splints reaching maximum absolute values of 0.50 mm. Based on this pilot study, it appears that osteopathic treatment may be capable of inducing spatial changes in the maxilla due to sutural movement thereby validating the fundamental principles of osteopathic treatment. Although, based on the study conducted, it cannot be concluded that osteopathy constitutes a successful treatment alternative in TMD patients, practitioners should be aware of this treatment modality.

Virtual Surgical Planning for Orthognathic Surgery Using Digital Data Transfer and an Intraoral Fiducial Marker: The Charlotte Method

We describe an alternative workup protocol for virtual surgical planning of orthognathic surgery using an intraoral fiducial marker, clinical photography, and the digital transfer of occlusal data. Wealso discuss our initial experience using this protocol in a series of patients. A retrospective cohort study was performed of consecutive patients who had undergone combined maxillary and mandibular osteotomies for the correction of dentofacial deformities at 1 center. These patients underwent treatment planning using the modified virtual surgical planning protocol described in the present report. The primary outcome evaluated was the accuracy of the method, which was determined through superimposition of the surgical plan to the postoperative cone-beam computed tomography (CBCT) scan. The secondary outcomes included the accuracy of the natural head position readings and the adequacy of the CBCT scanned stone models for the fabrication of occlusal splints. The population included 25 patients. The root mean standard deviation (RMSD) from the preoperative plan to the postoperative scan at the maxillary cephalometric points was 1.2, 1.4, and 2.1mm in the axial, sagittal, and coronal planes, respectively. The RMSD of the superimposed plan to the postoperative scan at the 3 mandibular cephalometric points was 1.2, 0.8, and 0.7mm in the axial, sagittal, and coronal planes, respectively. The average variance from the axial, sagittal, and coronal planes for the natural head position was 0.05, 2.22, and 0.69 mm, respectively. All splints fabricated from the CBCT occlusal data fit the stone models and were used intraoperatively. In the subset of patients whose models were both digitally transferred and laser scanned, the superimposition of the laser scan data to the CBCT scanned data was found to have a maximum variation of 0.2mm at the occlusal level. The use of an intraoral fiducial marker changed the workflow for the data collection needed for virtual surgical planning of the correction of dentofacial deformities, while still obtaining accurate results. Because the device does not cause lip distortion, the possibility of virtually predicting a more expectant postoperative lip position exists without the need for additional scans. Furthermore, this work flow allows the transfer of data to be isolated to digital media.

Arbitrary versus exact mounting procedure during fabrication of intraoral splints: an exploratory randomised controlled clinical trial

The present study examined possible advantages of a kinematical determination of hinge axis points over arbitrary axis points in the fabrication of occlusal splints for CMD treatment. The single blinded prospective randomised trial was performed in a general dental practice. A total of 14 consecutive patients presenting for CMD treatment were considered for participation and declared informed consent, and 12 patients (average age about 40 years) eventually participated. These patients were randomly assigned to either fabrication method and were not informed about how their individual splint was constructed. Condylography, required for the kinematical hinge axis determination, was therefore performed in both groups. Patients were recalled after 1, 2, 4, 14 and 28 days, and splints were selectively ground in order to achieve full occlusal contact in 12 points. The required number of corrective grindings was recorded, as was the clinical course of the patients. Kinematical splint construction yielded the desired result – mandibular repositioning as reflected by the full number of occlusal contact points – faster and more completely than the employment of an arbitrary hinge axis, and substantially (about 50%) less corrective grinding was required. The difference was statistically significant despite the rather small sample size. Clinically, both methods appeared to be equally effective. The greater initial effort required by kinematical determination of the individual hinge axis seems to be at least partially outweighed by a lower amount of corrective grinding required achieving the desired splint effect. Which method has the superior cost-benefit ratio remains to be determined.

Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients

Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p<0.05). There were no significant differences (p>0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive.

A new computer-assisted method for design and fabrication of occlusal splints

In this report, we describe computer-based design and production of occlusal splints. A research effort was undertaken to develop a process to eliminate the inherent variabilities associated with current splint-fabrication methods. The digital process provides quantitative control over articulation and splint design, and produces splints with continuously smooth occlusal surfaces. Stone casts are laser scanned, and custom software is used to articulate and design flat-plane and full-coverage splints with guidance ramps. Splints are produced by milling excess acrylic placed over stone casts. Clinically, digital splints reduce the average time needed for placement because intraoral equilibration is minimized.

A Novel Model Surgery Technique for LeFort III Advancement

Current techniques for model surgery and occlusal splint fabrication lack the ability to mark, measure and plan the position of the orbital rim for LeFort III and Monobloc osteotomies. This report describes a model surgery technique for planning the three dimensional repositioning of the orbital rims. Dual orbital pointers were used to mark the infraorbital rim during the facebow transfer. These pointer positions were transferred onto the surgical models in order to follow splint-determined movements. Case reports are presented to illustrate how the model surgery technique was used to differentiate the repositioning of the orbital rim from the occlusal correction in single segment and combined LeFort III/LeFort I osteotomies.

Polymerization characteristics of light- and auto-curing resins for individual splints

The aim of this in vitro study was to assess different resins for occlusal splints regarding a number of polymerization characteristics. One autopolymerizing resin (Palapress) and four light-curing resins (Acrylight, Primosplint, Triad TranSheet Colorless and Pink) were tested for flexural strength, modulus of elasticity, water sorption, volumetric shrinkage, and conversion of double bonds. These resins were polymerized for 10 and 15 min in a light oven at frequencies between 320 and 400 nm or 400 and 500 nm, respectively. Data were treated statistically by ANOVA and by Scheffé test. Concerning flexural strength and modulus of elasticity, Triad TranSheet Colorless showed significantly greater values than Primosplint and Palapress (p<0.05). The light curing resins Acrylight and Primosplint featured significantly higher water sorption when cured for 10 min compared to all other resins (p<0.05). Acrylight displayed significantly higher volumetric shrinkage and a higher quantity of remaining double bonds compared to all other light-curing resins (p<0.05). Primosplint, Triad TranSheet Colorless and Pink showed significantly lower shrinkage values than autopolymerizing Palapress (p<0.05). For all light curing resins, polishing of the samples resulted in a significantly lower quantity of remaining double bonds (p<0.05) compared to unpolished samples. With respect to the polymerization properties evaluated, the light-curing resins reached similar material properties to the autopolymerizing resin or even surpassed them. Light-curing resins seem to be suitable for the fabrication of occlusal splints and can been seen as an alternative to autopolymerizing polymethylmethacrylates.