Hard Splint Research Articles

Comparative efficacy of different thicknesses of soft and hard splints in reducing clinical symptoms in patients with temporomandibular disorders

Introduction: The effectiveness of two soft and hard splint thicknesses in reducing temporomandibular joint (TMJ) pain and dysfunction was compared.
 Materials and Methods: Sixty patients with TMJ pain and dysfunction were randomly assigned to four groups (n=15); the patients treated with hard occlusal splints of 1 and 3mm thicknesses were assigned to Groups A and B, respectively, and those treated with soft occlusal splints of 1 and 3mm thicknesses were assigned to Groups C and D, respectively. Maximum mouth opening (MMO) and the severity of pain based on the visual analog scale (VAS) were assessed before treatment and after 7, 30 and 90 days.
 Results: After both 7 and 30 days, no significant differences were found between the groups for any variable (P>0.05). However, Group C had a significantly lower MMO compared to Groups A and B after 90 days (P=0.001). Additionally, and in relation to masticatory muscle pain, Group C had a significantly higher VAS score than other groups (P<0.05). The VAS score for TMJ pain at rest was also significantly higher in Group C compared to Groups A and B (P<0.05).
 Conclusion: A 3-mm hard occlusal splint seems to be the best treatment to reduce pain and dysfunction of the TMJ.

Comment on: "Comparison of the effectiveness of soft and hard splints in the symptomatic management of temporomandibular joint disorders".

Comment on: "Comparison of the effectiveness of soft and hard splints in the symptomatic management of temporomandibular joint disorders".

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years±10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Comparison of the effectiveness of soft and hard splints in the symptomatic management of temporomandibular joint disorders: A randomized control study.

Splint therapy is a well-established modality in the management of temporomandibular joint disorders (TMDs). We aimed to evaluate and compare the effectiveness of hard and soft splints in the symptomatic management of TMDs using the modified Helkimo index. This study included 91 patients diagnosed with TMDs. Participants were randomly allocated into two treatment groups. All these patients were treated by hard or soft stabilization splint therapy. Group 1: hard splint group, n=42 (mean age - 31.62 ± 8.5 years), 10 males and 32 females; group 2: soft splint group, n=49 (mean age - 32.86 ± 9.06 years), 13 males and 36 females. The anamnestic and clinical dysfunction component of the modified Helkimo index was used to evaluate the outcomes at baseline (T0 ), first month (T1 ), and third month (T2 ). Symptoms such as clicking of the joints, temporomandibular joint (TMJ) pain and muscle pain showed improvement in both groups (P< .05). Restriction and deviation of mouth opening did not show significant improvement in either group. The patients who underwent hard splint therapy showed an early improvement of symptoms at T1 (P< .05). However, there was no statistical difference in the improvement of symptoms between hard and soft splints at T2 . Both hard and soft stabilization splints were effective in the symptomatic management of TMDs. However, hard splints provide an earlier reduction of symptoms.

Rehabilitation following surgical management of MNETI: A splint in time saves nine!

IntroductionMelanotic neuroectodermal tumour of infancy (MNTI) is a rare, rapidly growing pigmented neoplasm of neural crest origin generally arising in infants during the first year of life. The rehabilitation of the anterior defect is necessary to circumvent feeding problems. The area is also a site for primary growth of maxilla and placing a hard splint would restrict the same. We have used a novel way to use a soft splint to overcome this issue with follow up and re-fabrication. CaseWe report a 7 months old male who presented with a rapidly growing mass history of a rapidly growing mass in the upper front part of the jaw A biopsy showed melanoticneuroectodermal tumour, and complete resection with negative margins was subsequently achieved. The patient was reviewed at follow up with a magnetic resonance imaging, which showed no residual remanants. Rehabilitation was done with a soft splint to avoid restriction of maxillary growth. ConclusionDue to its rapid growth potential and locally destructive behaviour, early diagnosis is extremely important to limit local expansion. The treatment of choice for melanotic neuroectodermal tumour of infancy (MNTI) is surgical excision. Rehabilitation is also important with due attention to avoiding restriction maxillary growth, this was overcome by use of soft splint which has scantly been reported in literature.

Rehabilitation following surgical management of mneti: a splint in time saves nine!

Introduction: Melanotic neuroectodermal tumour of infancy (MNTI) is a rare, rapidly growing pigmented neoplasm of neural crest origin generally arising in infants during the first year of life. The rehabilitation of the anterior defect is necessary to circumvent feeding problems. The area is also a site for primary growth of maxilla and placing a hard splint would restrict the same. We have used a novel way to use a soft splint to overcome this issue with follow up and re-fabrication. Case report: We report a 7 months old male who presented with a rapidly growing mass history of a rapidly growing mass in the upper front part of the jaw a biopsy showed melanotic neuroectodermal tumour, and complete resection with negative margins was subsequently achieved. The patient was reviewed at follow up with a magnetic resonance imaging, which showed no residual remnants. Rehabilitation was done with a soft splint to avoid restriction of maxillary growth. Conclusion: Due to its rapid growth potential and locally destructive behaviour, early diagnosis is extremely important to limit local expansion. The treatment of choice for melanotic neuroectodermal tumour of infancy (MNTI) is surgical excision. Rehabilitation is also important with due attention to avoiding restriction maxillary growth, this was overcome by use of soft splint which has scantly been reported in literature.

A clinical trial: Aqualizer ™ therapy and its effects on myopathies or temporomandibular dysfunctions. Part I: Objective parameters

ABSTRACT Objective Symptoms of temporomandibular dysfunction (TMD) may include pain in the muscles or restrictions opening the mouth. The aim of this study was to assess the effects of initial Aqualizer™ therapy. Methods Group 1 received initial Aqualizer™ therapy before definitive hard splint; Group 2 received no initial therapy. Patients with arthrosis, partial/total prosthesis or undergoing splint therapy were excluded. Objective (temporomandibular joint palpation, temporomandibular joint auscultation, palpation of the chewing muscles, and mobility of the lower jaw) parameters were evaluated. The level of statistical significance was 5% (p < 0.05). Results In 53 patients (Group 1 n = 25; Group 2 n = 28), a significant improvement (p < 0.001) was found in Group 1 in pain on palpation (masseter muscle, temporal muscle, post-mandibular region, lateral pterygoid muscle, and suboccipital region), but no significant differences in jaw mobility were found. Conclusion Aqualizer™ therapy produces significant improvement of primary symptoms.

Comparative evaluation of soft and hard splints in treatment of clenching disorder

Introduction: The aim of this study was to compare the efficiency of soft and hard splints in treating patients with clenching. Materials and Methods: In this clinical study, 26 patients with clenching disorder random- ly divided to two equal group of treatment: hard and soft splint. The amount of masticatory muscle pain and maximum mouth opening were measured at the delivery time and 3, 6, 9, and 12 weeks later by a blind examiner. Data were analyzed by independent T and repeated measure ANOVA tests with significance level of p=0.05. Results: Hard and soft splints were resulted in significant reduction of masticatory muscle pain (hard: P&lt;0.001, Soft: p&lt;0.001) and increase in maximum opening (hard P&lt;0.001, Soft p&lt;0.003), but there was no significant difference between them in pain relieving (P=0.848) and maximum opening (P=0.622). Conclusion: This study showed that efficacy of hard and soft splints in treating patients with clenching is same.

Preliminary clinical evaluation of traditional and a new digital PEEK occlusal splints for the management of sleep bruxism.

To compare the manual time and preliminary clinical effects between the digital manufactured occlusal splints for sleep bruxism patients with those of traditional hard splints. Sixteen individuals (18 to 44y/o) with clinically diagnosed sleep bruxism were selected based on the inclusion criteria. All patients were divided into two groups, and a random control method was applied. Digital splints (test group) were designed and milled using CAD/CAM. Hard splints (control group) were made of transparent acrylic resin in laboratory office. The manual time spent including impression obtaining, splint production and clinical occlusal adjustment was recorded. A visual analog scale was used to report the subjective evaluations. The maximum depth loss and volumetric loss of the occlusal surface of splints in posterior tooth were measured. SPSS software was used for statistical analysis (P=.05). Comparing with control group, the manual time spent in test group was significantly less in all of three procedures (P<.001). The VAS scores for retention were not significantly different (P=.086), but the wearing comfort scores of test group were significantly higher (P<.001). Both maximum depth loss (P=.007) and volumetric loss in test group were significantly less than control group (P=.005). In the current study, the digitally manufactured splints exhibit significantly improved comfort and time efficiency than traditional hard splints. Moreover, the new milling material (PEEK) has better wear resistance than acrylic resins.

Assessment and evaluation of errors in tooth preparation by undergraduate students: an institution based in-vitro study

Aim: To assess the errors made during preclinical tooth preparation by the undergraduate students of Meenakshi Ammal Dental College and Hospital, Chennai. Objectives: To understand the reason, nature and frequency of the errors occurring during tooth preparation done by undergraduate dental students during their preclinical practice. Materials and Methods: A total of hundred samples were collected from the undergraduate students. All the samples were upper right central incisors (11) typodont teeth, prepared to receive an All-ceramic crown. All the samples were prepared by mounting the typodont (NISSIN Typodont Jaw Model) on a phantom head simulator. All the preparations were made as freehand preparations. The following aspects of the preparation were evaluated: 1. Facial and palatal reduction 2. Occlusal clearance 3. Finish line width The evaluation of all the three aspects was done by studying a cross-section of an impression made on the prepared tooth. The impressions were made using a hard splint, which was fabricated on the typodont jaw model, prior to tooth preparation, as an impression tray. The impression material used was Light body(Zhermack Elite HD – Light normal set) impression material Results: The measurements and values obtained were subjected to statistical analysis to obtain the final result. Regarding the amount of prepared tooth surface, the frequency of errors encountered was more with regard to palatal reduction. Regarding the width of the finish line, Labial aspect of the finish line was most commonly under prepared. Conclusion: Within the limitations of the study, the main recommendation is to increase the pre-clinical practice time to emphasise more on the clinical expertise and the importance of proper operator positioning during tooth preparation. Key Words:Tooth preparation, All-ceramic restorations, Errors

Evaluation of decontamination methods of oral biofilms formed on screw-shaped, rough and machined surface implants: an ex vivo study

BackgroundTo evaluate the effect of several representative decontamination methods of oral biofilms on different implant surfaces.Material and methodsEleven participants wore a hard resin splint carrying 6 rough (GC Aadva® implant; 3.3-mm diameter, 8-mm length) or machined (not commercially available) surface implants for 4 days to accumulate dental plaque naturally on the titanium surfaces of the implants. Apart from surface roughness, the morphology of all implants was identical. After detaching the implants from the splints, the ability of the following decontamination methods—gauze soaked in saline (G), ultrasonic scaler (US), air abrasive (Air), rotary stainless steel instrument (Rot), and Er:YAG laser (Las)—to cleanse the contaminated implant surface for 1 min extra-orally was tested. The control (Cont) group did not receive any decontamination. Scanning electron microscopic (SEM) investigation of one participant’s samples was employed to examine the post-instrumented implant surface for qualitative analysis, and bacterial culture of the remaining 10 participants’ samples was performed to count the number of colony-forming units (CFU) for quantitative analysis. The experimental sequence was initially performed for the rough surface implants and then similarly repeated for the machined surface implants. Bacterial CFU counts among the six groups were analyzed using the Steel-Dwass test, and differences between rough and machined surface implants were determined using the Mann-Whitney U test.ResultsG and Rot eliminated most biofilms on machined surface implants according to SEM analysis. G, Air, and Rot removed significantly more of the biofilms on rough and machined surface implants compared with US according to CFU counts. Moreover, G significantly reduced more biofilms than Las on machined surface implants. The analysis between rough and machined surface implants showed that Cont, G, and US were better able to cleanse biofilms on machined surface implants compared with rough surface implants.ConclusionsGauze soaked in saline and rotary stainless steel instruments may be advantageous for cleansing contaminated implant surfaces based on the qualitative and quantitative analyses. In contrast, air abrasives were not shown to be preferable in the qualitative analyses. Additionally, apart from the Er:YAG laser, the reduction of biofilms assessed in both qualitative and quantitative analyses demonstrated that all decontamination methods were better at cleansing machined surface implants compared with rough surface implants.

Evaluation of Different Kinds Of Occlusal Splints Therapy in the Management of Myofascial Pain

The aim of the study was to compare patient satisfaction with different types of stents using visual analogue scale and Pain report analysis.Materials and methods: Thirty dentulous patients were selected, based on the clinical examination, the patients were suffering from pain in the temporomandibular joint region that might be worse in the morning or associated with eating,tenderness of temporomandibular joint with palpation at rest and/or at function, pain and/or tenderness of masseter and temporalis muscle.The patients were randomly divided into three equal groups, ten patients in each group. Splints were constructed for the upper arch of each patient. Soft, hard and 3 Dprinted stents were fabricated. Pain intensity questionnaire (visual analogue scale) and Pain report analysis were used before treatment, after three months and six months.Results: Kruskal-Wallis test was used to analyze the ordinal scale date of the visual analogue scale and pain report analysis. There was significance difference between the three groups. (Soft, hard and three D printed) after three month and six month of using the stent. Wicoxon test was used to test for significance between the different groups at three months and six months. The Wilcoxon test for visual analogue scale at three months showed that the hard and 3D printed stent are statistically significant to soft splint. The same was for the six months period. While Wilcoxon test for pain report analysis at 3 months didn’t show any statistical significance between the three groups, while at six month there was statistical significance between the hard splint and the 3 D printed splint with the soft splint. Friedman’s test was used to compare between different time intervals inside the groups. There was a statistical significance between the three groups during the three months and six months interval time of the treatment.Conclusion: All patients improved over time. The results showed that both hard and soft splints are effective but the hard splint and the three D printed splints are more effective compared to soft splint.

Stabilization Splint (Night Guard, Mouth Guard) Comparative Research

This research compares between the effect of flexible and hard stabilization splint (night guard, mouth guard) in the treatment of patients with tempro-mandibular joint problems.Four different categories of patients are used for comparison, each composed of ten patients. Category number one and two are treated with flexible mouth guard, while category three and four are treated with hard type of mouth guard for the same periods of time, one month and three months respectively. Analysis of the results indicate that patient category treated with soft stabilization splints for longer period of time show improved treatment and the patients are more relived and willing to continue the treatment than those treated with hard splints.

Comparison of three different options for immediate treatment of painful temporomandibular disorders: a randomized, controlled pilot trial

Objective: The purpose of this study was to compare the short-term effectiveness of three different types of immediate, non-pharmacological intervention for alleviation of the painful symptoms of temporomandibular disorders (TMD).Material and methods: Thirty-six patients (mean age 41.6 ± 16.7 years, 25 females) diagnosed with non-dysfunctional painful TMD received counselling and subsequently were randomly allocated to three treatment groups: patients in Group A received prefabricated oral splints with water-filled elastic pads (Aqualizer®), those in Group B were provided with vacuum-formed co-polyester oral splints and those in Group C were given appointments to receive Michigan-type hard splints. Clinical examination was conducted, at baseline and after 2 weeks, by use of the RDC/TMD. Current pain intensity was determined by evaluation of graded chronic pain status (GCPS) on a numerical rating scale (NRS). Active maximum mouth opening without pain (AMMOP) was also measured. Paired sample t-tests and one-way analysis of variance with a significance level of p ≤ 0.05 were conducted.Results: After 2 weeks, overall mean current pain was reduced by 41.95% (p < 0.001). Current pain reduction was significant for Group B (66.6%, p < 0.001) but not for Groups A (37.88%, p = 0.56) and C (22.29%, p = 0.26). After 2 weeks, current pain level for Group B was significantly lower than that for Group C (p = 0.041). Overall, there was a statistically significant increase of AMMOP (p = 0.01).Conclusion: All therapeutic options were pain-reducing. The results from this study suggest that cost-effective and time-effective intervention of counselling combined with use of a vacuum-formed splint is a favourable option for initial, short-term treatment of painful TMD.

Regional brain activity during jaw clenching with natural teeth and with occlusal splints: a preliminary functional MRI study

Objective: The purpose of this study was to investigate regional brain activity during jaw clenching with natural teeth and with two types of occlusal splints using functional magnetic resonance imaging (fMRI).Methods: Sixteen healthy volunteers were enrolled in this study. Blood oxygenation level-dependent (BOLD) fMRI signals were compared under three conditions: during clenching with natural teeth, with a soft splint, and with a hard splint. For each condition, 30-second jaw clenching followed a 60-second rest, and was repeated three times, with intervening 30-second rests. SPM 8 was used for the fMRI analysis.Results: Blood oxygenation level-dependent signals during clenching with natural teeth increased in BA44, 45, and the cerebellum. Blood oxygenation level-dependent signals increased in those areas and in BA17, 18 during clenching with a soft splint. Use of the hard splint increased the BOLD signals in BA6 and BA20, 37 in addition to the areas previously mentioned. Blood oxygenation level-dependent signals in the left BA6, the left BA20, 37, and the right BA44, 45 were significantly higher during clenching with a hard splint than with natural teeth. These regions are associated with motor coordination, memory, and cognition, respectively.Conclusion: Jaw clenching with a hard splint caused activity in the widest brain regions, including the associated area with motor coordination.

Dentists' knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders.

The aim of this study was to investigate dentist's approaches to the use of splint therapy for myofascial pain, bruxism, and temporomandibular joint (TMJ) disorders and to assessment of treatment modalities. A 12-item questionnaire was developed to determine dentists' knowledge of TMJ disorders and approaches for occlusal splint treatments. The researchers spoke with each dentist included in the study at his/her clinic or by telephone to assess their immediate knowledge and approach to the TMJ disorders. Chi-squared test was performed to analyze the values. The confidence interval was set as 95%. A total of 370 dentists working in Turkey were participated in this study. The most common splint application reason for occlusal splint treatment was bruxism (77.8%) while TMJ pain was very rare (%1.4). The use of hard splint ratios for 0-5 years of professional experience was 57.0%, 42.4.0%, and 26.8% for the experience of 5-15 years and over 15 years groups, respectively (P < 0.001). While the dentists' with sufficient knowledge soft splint application rates were 11.6%, hard splint application rates were 43.4% for the dentists with sufficient knowledge. Occlusion adjustment rate of dentists who practice in all three groups was under 16.0%. The knowledge of the dentists about TMJ disorders and occlusal splint therapy were found to be insufficient. Their knowledge decreased with increasing experience.

Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofascial pain.

Purpose:To determine the efficacy of hard, liquid, and soft splints in the management of myofascial pain dysfunction syndrome.Materials and Methods:In this randomized clinical trial, 45 patients with myofascial pain were diagnosed and were randomly assigned into three groups of 15 patients each. Group 1 - subjects were given hard splint, Group 2 - soft splint, and Group 3 - liquid oral splint for 3 months. Subjective pain analysis using Modified Symptom Severity Index (Mod-SSI) and objective pain analysis muscle palpation was performed at 7 days, 1 month, 2 months, and 3 months after splint insertion. The changes in mean pain value by both methods, in all three groups, were analyzed with Tukey test and Kruskal–Wallis H-test, respectively (P < 0.05).Results:Both Mod-SSI and palpation scores showed statistically significant reduction in pain for all three groups at the end of 3 months. However, the hard splints proved to be very effective in a shorter period of time, followed by liquid splints and finally soft splints.Conclusion:The result of this study advocates the use of any one of the three types of the occlusal splints in the therapeutic management of myofascial pain due to temporomandibular disorders.

Regional brain activity during jaw clenching with natural teeth and with occlusal splints: a preliminary functional MRI study

AbstractObjective: The purpose of this study was to investigate regional brain activity during jaw clenching with natural teeth and with two types of occlusal splints using functional magnetic resonance imaging (fMRI).Methods: Sixteen healthy volunteers were enrolled in this study. Blood oxygenation level-dependent (BOLD) fMRI signals were compared under three conditions: during clenching with natural teeth, with a soft splint, and with a hard splint. For each condition, 30-second jaw clenching followed a 60-second rest, and was repeated three times, with intervening 30-second rests. SPM 8 was used for the fMRI analysis.Results: Blood oxygenation level-dependent signals during clenching with natural teeth increased in BA44, 45, and the cerebellum. Blood oxygenation level-dependent signals increased in those areas and in BA17, 18 during clenching with a soft splint. Use of the hard splint increased the BOLD signals in BA6 and BA20, 37 in addition to the areas previously mentioned. Blood oxygenation level-d...

Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs).

AimTo compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction (MPD) or internal derangement (ID) of the temporomandibular joint (TMJ) with reciprocal clicking.Patients and methodsThis study included 50 patients (age range: 24–47 years) who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets (soft splint group) or a hard flat occlusal splint fabricated from transparent acrylic resin (hard splint group). Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening).ResultsAll parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit.ConclusionsBoth forms of occlusal splints (soft and hard) improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use.

Cost effectiveness of arthrocentesis as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial

Objective: To determine the cost effectiveness of arthrocentesis as initial treatment compared to care as usual (CAU) for temporomandibular joint (TMJ) arthralgia. Materials and methods: 80 patients were randomly allocated to arthrocentesis as initial treatment (n = 40) or CAU (n = 40). Arthrocentesis was performed under local anaesthesia. The joint was rinsed with at least 300 ml isotonic saline chloride and no additional substances or drugs were applied. CAU consisted of a soft diet, physical therapy (which involved a home exercise program, joint mobilisation, and physical treatment modalities), and splint therapy using an intra-oral hard acrylic splint. Follow-up was after three, 12 and 26 weeks. Main outcome measures: Cost effectiveness, i.e. total costs from a societal point of view related to TMJ pain as measured on a visual analogue scale (VAS 0-100 mm) and cost utility, i.e. quality adjusted life years (QALY). Results: After 26 weeks, in both groups (arthrocentesis n = 36; CAU n = 36) TMJ pain had declined. Generalized estimating equation (GEE) models for the clinical effectiveness, based on intention to treat, showed significant differences between arthrocentesis as initial treatment and CAU (regression coefficient beta =-10.76 (95% confidence interval -17.75 to -3.77), p = 0.003). Estimated mean total (societal) costs during 26 weeks were D 589 ($795) in the arthrocentesis group and D 1680 ($2266) in the CAU group. With regard to cost effectiveness, arthrocentesis dominated CAU in about 98% of the bootstrap simulations.With regard to cost utility, arthrocentesis dominated CAU in approximately 95% of the bootstrap simulations. Conclusions: The results of this study suggest that arthrocentesis as initial treatment is cost effective in reducing TMJ pain compared to CAU. However, due to substantial missing data, current results with regard to cost effectiveness should be interpreted with caution.