Interocclusal Splint Research Articles

Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial

Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.

Is there a difference in surgical accuracy following bimaxillary surgery between cleft and non-cleft patients?

To assess the surgical accuracy of 3D virtually planned orthognathic surgery among patients with and without cleft. This retrospective cohort study included cleft and non-cleft patients with class III malocclusion who underwent bimaxillary surgery. CBCT scans were acquired before and immediately after surgery. 3D virtual surgical planning (VSP) was performed using CBCT and digitalized dentition data. All orthognathic surgeries were performed by the same surgeons using interocclusal splints. The primary outcome variable was surgical accuracy, defined as the difference between the planned and surgically achieved maxillary movements, quantified in six degrees of freedom. Analysis of covariance was used to test for intergroup differences in surgical accuracy after correcting for differences in the magnitude of planned surgical maxillary movements. Twenty-eight cleft and 33 non-cleft patients were enrolled, with mean ages of 18.5 and 25.4 years, respectively (P=0.01). No significant gender difference was present between the groups (P=0.10). After adjustment for small differences in surgical movements, no significant differences in surgical accuracy were observed between cleft and non-cleft patients. The present study demonstrates that high surgical accuracy in maxillary movements can be achieved in both cleft and non-cleft patients using VSP and interocclusal splints. Orthognathic cases with cleft can be performed with 3D VSP to obtain a satisfactory surgical accuracy.

Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial

ABSTRACT Objective To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD). Methods One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58). Results Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up. Conclusion Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.

Holistic management of mutilated dentition

Background: Worn dentition has become a common and crucial issue, especially in the older generation. Beyond esthetics, functional diminution can create a serious impact on the overall well-being of the individual. The etiology of the worn dentition can be multifactorial; therefore, the treatment approach should be systematic and must not only address the existing problem but also prevent any recurrence. Case Report: Rehabilitation of a patient with worn dentition requires proper clinical, radiographic examination and recording of the occlusal vertical dimension (OVD). In this case report, a 65-year-old male patient presented with worn out and missing teeth in his upper and lower jaws. An arbitrary face-bow transfer was conducted, and the diagnostic casts were articulated. A mock full contoured wax up with a raised OVD of approximately 4 mm was completed. After 3 months of interocclusal splint therapy with the raised OVD, temporary restoration was cemented. After a follow-up period of 3 months, when the patient was devoid of any signs and symptoms, permanent restorations fabricated using computer-aided design and computer-aided manufacturing were cemented. An interocclusal splint was provided to preserve the restorations. Conclusion: Rehabilitating patients with worn dentition involves careful decision-making during the diagnosis as it will direct the entire treatment sequence. This case report and the resulting steps involved might serve as guidelines for other clinicians while treating similar patients.

Landmark-Based Versus Voxel-Based 3-Dimensional Quantitative Analysis of Bimaxillary Osteotomies: A Comparative Study

We compared the accuracy of landmark-based and voxel-based 3-dimensional (3D) analysis to quantify the osseous movements of the maxilla and mandible after bimaxillary osteotomy. Cone beam computed tomography (CBCT) scans of 15 patients who had undergone bimaxillary osteotomy were randomly selected from the database. Before surgery, CBCT scanning was performed and an individualized 3D virtual surgical plan made for all patients. During surgery, the mandibular and maxillary segments were positioned as planned using 3D-milled interocclusal splints. At 1week after surgery, a postoperative CBCT scan was acquired. All pre- and postoperative CBCT data were rendered in 3 dimensions. The 3D virtual head models were superimposed on the cranial base. The 3D surgical movements of the maxilla and mandible were quantified using conventional landmark-based 3D cephalometric analyses and voxel-based 3D analyses (OrthoGnathicAnalyser). This process was performed by the same observer 3 times. The intraclass correlations and Bland-Altman plots were computed to quantify the measurement errors and reproducibility of both methods. High intraclass correlation coefficients were found for both methods. The voxel-based analyses yielded a higher correlation concerning the maxilla and distal mandible (r=0.98) compared with the landmark-based cephalometric analyses (r=0.90). The use of voxel-based 3D analyses in the quantification of osseous movements was more reliable and reproducible than the use of conventional landmark-based 3D analyses.

Do Splints Play a Role in the Management of Condylar Postfracture Syndrome After Mandibular Angle Fractures?—A Randomized Controlled Clinical Trial

Fractures of the mandibular angle can result in condylar postfracture syndrome (CPFS) due to indirect injury to the condylar region. Studies evaluating early intervention for CPFS are lacking. In the present study, we evaluated the efficacy of interocclusal splint therapy for the prevention and early management of CPFS. A prospective randomized controlled clinical trial was designed and included patients who required open reduction and internal fixation for a unilateral angle fracture. The patients were divided into 2 groups. The study group received interocclusal splints postoperatively and the control group did not receive such splints. The patients were followed up at 2weeks and 1, 2, and 3months. The primary outcome measure was the presence or absence of CPFS after 3months. CPFS was defined as the presence of any 1 of the clinical signs of temporomandibular joint dysfunction. The secondary outcomes included the mean pain scores and degree of mouth opening, which were evaluated at each follow-up visit. The study included 40 patients, with 20 patients each randomized to the study and control groups. At the end of 3months, CPFS was present in 2 patients in the study group and in all 20 patients in the control group. The mean pain scores were significantly lower in the study group than in the control group, and the mean mouth opening was significantly greater. The use of interocclusal splints was found to be effective in the prevention and early management of CPFS. The use of splints also resulted in decreased pain and an improved mandibular mouth opening.

Role of transpalatal vault fixation with 2.0 plate for transverse palatal expansion in segmental le fort osteotomy

Background: Segmental Le Fort I osteotomy is a predictable, well-established surgical technique that is commonly used to correct maxillary transverse discrepancies up to 6–7 mm in adults. However, transverse expansion of the maxilla with a segmental Le Fort I osteotomy is often associated with postsurgical instability and relapse. Different methods have been recommended to reduce the potential for transverse instability involving bone grafts or allografts at the palatal osteotomy site, use of palatal bars and expanders, interocclusal splints and transpalatal bone-anchored devices. However, transverse maxillary expansion with a segmental Le Fort I osteotomy is still considered the least stable surgical orthognathic procedure and overexpansion with stable fication method frequently recommended.

Gap arthroplasty with active mouth opening exercises using an interocclusal splint in temporomandibular joint ankylosis patients

BackgroundTemporomandibular joint (TMJ) ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating as well as in breathing during sleep. The purpose of this study is to describe the effectiveness of an interocclusal splint (IOS) for active mouth opening exercises in the treatment of TMJ ankylosis.MethodsA total of nine patients with 13 instances of TMJ ankylosis from 2008 to 2010 were included in this study, of which five patients were male and four patients were female. Five patients demonstrated unilateral ankylosis, while five patients showed bilateral symptoms. Ankylosed mass resection with coronoidectomy, fibrotic scar release, and resection of stylohyoid ligament calcification was performed with gap arthroplasty without an interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 6.6-year follow-up period.ResultsAll patients were subjected to postoperative mouth opening exercises from the day of the operation with the help of an IOS, which was based on an impression taken during surgery. All patients were sufficiently comfortable moving their mandible according to the IOS’s guiding plane and impingement, and satisfactory results were achieved, in which MMO was improved by 35 mm more than 6 years after surgery.ConclusionsComplete and adequate resection of the ankylosed mass and postoperative active mouth opening exercises are essential in the treatment of TMJ ankylosis. Moreover, a more comfortable mouth opening guide and interdigitation can be achieved using an IOS, and newly organized fibrosis in the gap space between the newly made resected condylar head and temporal fossa can be suggested.

Comparison of the Planned Versus Actual Jaw Movement Using Splint-Based Virtual Surgical Planning: How Close Are We at Achieving the Planned Outcomes?

Virtual surgical planning and interocclusal splints are commonly used in performing orthognathic surgery. The benefits are well known, but how close do surgeons come to achieving the planned movements? The aim of this study was to answer this question. This was a retrospective cohort study of patients who underwent maxillary and mandibular osteotomies to correct their dentofacial deformity. The predictor variable consisted of the virtually planned 3-dimensional (3D) positions of the maxillary and mandibular centroids and maxillary central incisor. The outcome variable consisted of the postoperative 3D positions of these points. Absolute differences were calculated using the root mean square deviation. Other variables that could affect the outcome were assessed, which included skeletal classification, osteotomy sequence, and maxillary segmental surgery. Paired t test was used to determine the mean of the error for the outcome variable. A forward stepwise regression test was used to test for associations with the other variables. This study was composed of 15 patients with a mean age of 19years. The maxillary incisor was advanced 2.5 to 8mm. The mean of the error for the maxillary incisor in the anteroposterior dimension was -2.0mm, which was a statistically relevant under-advancement (95% confidence interval). The anteroposterior error for the maxillary centroid was significantly higher for a 1- than for a 3-piece Le Fort osteotomy (P=.008). Eight patients had under-advancement of more than 50% of the planned movement, which could be clinically relevant. The maxillomandibular complex was under-advanced. This could be due to surgeon-dependent variables and other factors that are not simulated with virtual planning. This could affect the desired lip and paranasal support. The surgeon needs to take this into account when planning esthetic objectives for surgery.

Accuracy of patient-specific implants and additive-manufactured surgical splints in orthognathic surgery — A three-dimensional retrospective study

IntroductionBecause of the many limitations of conventional surgery planning for the treatment of orthognathic deformities, as well as advancements in computer-assisted planning, there is an urgent need for technical devices that transfer the surgical plan into the operating theatre. In this regard, additive-manufactured, patient-specific implants (PSI) and additive-manufactured interocclusal splints represent promising approaches. The aim of this retrospective study was to compare the accuracy of these two devices, with regard to preoperative virtual treatment planning for maxillary Le-Fort I advancement surgery using IPS CaseDesigner®, and based on a new analysis method without the use of landmarks. Materials and methodsA retrospective evaluation of 18 class III patients (n(PSI) = 9; n(splint) = 9), who had undergone virtually planned orthognathic surgery (including maxillary Le Fort I advancement), was performed. The preoperative treatment plan and the postoperative outcome were combined to calculate the translational and rotational discrepancies between the 3D planning and the actual surgical outcome. ResultsFor the PSI and splint groups the accuracy of left/right positioning was 0.51 mm ± 0.48 and 1.11 mm ± 1.32 respectively. The accuracy of anterior/posterior positioning was 0.39 mm ± 0.26 and 1.42 mm ± 0.87, and that of up/down-positioning was 0.44 mm ± 0.31 and 0.62 mm ± 0.47. The rotational discrepancies were less than 2° in both groups. Conclusion: The findings demonstrate that both PSI and splint approaches can accurately transfer the virtual planning into the operating theatre. However, PSIs show an overall higher accuracy, especially for anterior/posterior translational movement (p < 0.002).

One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.

Recurrent mechanical complications in an implant-supported fixed complete denture: a clinical report

INTRODUCTION: Several factors can lead to mechanical complications in implant-supported fixed complete dentures (IFCD).CASE DESCRIPTION: This clinical report presents a clinical case of a maxillary IFCDP with recurrent mechanical complications and a possible causal interaction between patient’s intrinsic characteristics (bruxism and high occlusal force) and technical procedures (framework design, occlusal adjustment, interocclusal splint, and posterior occlusal support).CONCLUSION: The 3-year follow-up findings highlight the need for a comprehensive and systemic approach to manage a challenging case of an IFCD patient with moderate bruxism and high occlusal force.

Use of an intraoperative navigation system and piezoelectric surgery for styloidectomy in a patient with Eagle\u2019s syndrome: a case report

BackgroundElongated styloid process syndrome (Eagle’s syndrome) is the term given to the symptomatic elongation of the styloid process or the mineralization of the stylohyoid or stylomandibular ligament. The two commonly used approaches for the surgical treatment of this syndrome are the transcervical and transoral approaches. Both have their limitations and specific intraoperative risks. Here, we report the treatment of a patient with Eagle’s syndrome using the transoral approach in conjunction with piezoelectric surgery, surgical planning, and intraoperative navigation to reduce the risk of complications.Case presentationThe elongated styloid process was resected in a 45-year-old Japanese man using a minimally invasive approach with an intraoperative navigation system. Preoperative preparation involved the use of a custom interocclusal splint to produce the mouth opening conditions required during surgery. Using the three-dimensional position of the navigation probe, the location of the elongated styloid process was identified. After confirmation of the resection spot via the transoral approach, the styloid process was dissected by piezoelectric surgery. Follow-up examination showed an uneventful recovery with no associated complications.ConclusionThe resection of the styloid process using an intraoperative navigation system and a custom interocclusal splint during a transoral approach, together with a piezoelectric cutting device, is safe and effective for the treatment of Eagle’s syndrome.

Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism

ObjectiveThe purpose was to evaluate the effect interocclusal appliance therapy on bite force (BF), sleep quality and salivary cortisol levels in adults with SB diagnosed by polysomnography. As a secondary aim, signs and symptoms of temporomandibular dysfunction (TMD) were evaluated. DesignForty-three adults (19–30 y/o) were divided into two groups: experimental group (GSB), composed of 28 subjects with SB, and control group (GC), without SB and TMD (n=15). GSB was treated with stabilization interocclusal splint and evaluated at time intervals: before (baseline), one month (T1) and two months (T2) after therapy began, to collect data related to BF, sleep quality (Pittsburgh Sleep Quality Index), salivary cortisol levels and TMD. GC was also examined three times and received no therapy. Data were analysed by means of normality tests, t-test/Mann-Whitney and One-way ANOVA repeated measures (Tukey post-test). Two-way ANOVA test for repeated measures was applied to verify the effect time*group interaction on the variance of each dependent variable (α=0.05). ResultsGSB showed an increase in BF and a positive effect on muscular symptomatology, range of mandibular movements and sleep quality; in GC these parameters did not differ. Cortisol concentration decreased between baseline and T1 in GSB (F(1,31)=4.46; test power=62%; p=0.017). The variance observed for BF, TMD and sleep quality among time points was dependent on the group (moderate effect size: partial Eta square >0.16; test power >80%). ConclusionsThe results suggested that short-term interocclusal appliance therapy had a positive effect on BF, temporomandibular symptomatology, sleep quality and salivary cortisol levels in adults with SB.

Use of an intraoperative navigation system for retrieving a broken dental instrument in the mandible: a case report

BackgroundA fracture of root canal instruments, with a fractured piece protruding beyond the apex, is a troublesome incident during an endodontic treatment. Locating and retrieving them represents a challenge to maxillofacial surgeons because it is difficult to access due to the proximity between the foreign body and vital structures. Although safe and accurate for surgery, radiographs and electromagnetic devices do not provide a precise three-dimensional position. In contrast, computer-aided navigation provides a correlation between preoperatively collected data and intraoperatively encountered anatomy.However, using a navigation system for mandible treatment is difficult as the mobile nature of the mandible complicates its synchronization with the preoperative imaging data during surgery.Case presentationThis report describes a case of a dental instrument breakage in the mandible during an endodontic treatment for a restorative dental procedure in a 65-year-old Japanese woman. The broken dental instrument was removed using a minimally invasive approach with a surgical navigation system and an interocclusal splint for a stable, identically repeatable positioning of the mandible. Using the three-dimensional position of the navigation probe, a location that best approximated the most anterior extent of the fragment was selected. A minimally invasive vestibular incision was made at this location, a subperiosteal reflection was performed, and the foreign body location was confirmed using a careful navigation system. The instrument was carefully visualized and extruded from the apical to the tooth crown side and was then removed using mosquito forceps through the medullary cavity of the crown side of the tooth. Follow-up was uneventful; her clinical course was good.ConclusionsThe use of a surgical navigation system together with an interocclusal splint enabled the retrieval of a broken dental instrument in a safe and minimally invasive manner without damaging the surrounding vital structures.

Influence of the interocclusal splint in condylar position of patients with tmd: computed cone beam

The aim of this study was to evaluate the condylar position in patients with intra-articular temporomandibular disorders (TMD) before and after treatment with interocclusal stabilization splint (ISS) through computerized tomography cone beams (CTCB). Twenty-two patients diagnosed with intra-articular TMD (Research Diagnostic Criteria for Temporomandibular Disorders - Group II) were submitted to the therapy with ISS during 90 days. Three CTCB exams were performed in three moments: T1 – Initial moment, before the ISS therapy, with the patient in dental occlusion; T2 (after 90 days of treatment, in occlusion on the ISS) and T3 (after 90 days of treatment, with the patient in dental occlusion). Afterwards the anterior (AS), superior (SS) and posterior articular space (PS) in sagittal sections were then measured and the data were statistically analyzed using the t-test. There was a statistically significant increase in the comparison between T1 and T2 for the AS and PS (p&lt; 0.0001), between T3 and T2 for AS (p= 0.0008) and PS (p&lt; 0.0001). In comparison T1/T3 there was a significant increase in AS (p= 0.01) and SS (p= 0.04), and non-significant in PS (p= 0.89). The interocclusal splint provides temporary changes in condylar position, with a tendency to increase the joint space, varying in accordance with individual characteristics. Therefore, it should not be used as a single therapy, but combined with other strategies that include the TMD multidimensionality. The interocclusal splint has proved to be reversible and conservative therapeutic modality, as it does not generate permanent changes in joint tissues.

Effects of a resistance training program performed with an interocclusal splint for community-dwelling older adults: a randomized controlled trial.

[Purpose] To examine whether resistance training for elderly community-dwellers performed with an interocclusal splint resulted in greater lower extremity muscle strength and better balance than resistance training performed without an interocclusal splint. [Subjects and Methods] Eighty-eight elderly persons using Japanese community day centers were randomly divided into two groups: an intervention group (n=45), which performed resistance training with an interocclusal splint; and a control group (n=43), which performed resistance training without an interocclusal splint. The resistance training program comprised a 40-min session performed twice a week for 12 weeks. Outcome measures were the chair stand test (CST), timed up and go test (TUG), and one-leg standing test (OLST). Assessments were conducted before the intervention and every 2 weeks after the start of the intervention. [Results] There was a significant group × time interaction for the OLST, with the intervention group showing significant improvement from 8 to 12 weeks compared to the control group. For the CST and TUG, no significant differences were found between the two groups throughout the 12 weeks. [Conclusion] Resistance training with an interocclusal splint improved the balance ability of elderly community-dwellers more effectively than resistance training without an interocclusal splint.

Variations in soft facial tissue by using the interocclusal stabilization splint: 3d stereophotogrammetry

Objective: To analyze variations in soft facial tissue by using the interocclusal stabilization splint (ISS) through the 3D stereophotogrammetry technique in a group of young women with temporomandibular disorder (TMD). Material and Methods: 20 females between 20 and 60 years of age (39.3 ± 12.5) and TMD diagnosis based on the criteria of the RDC/TMD, received treatment with ISS. Reference points were marked on the face and photos were performed twice using the Vectra (M3–Canfield®): with and without ISS. In the 3D images the following variables were measured: area of the cheeks and lips (cm3), linear labial distances (Ls-Cph, Cph-Ch, Li-Ch, Ls-Li, Ch-Ch), lower third of the face (Sn-Me), height of the upper lip (Sn-Ls)/lower (Li-Me) and the angles C-Sn-Ls, N-Sn-Pg and Li-Sl-Pg. The data were analyzed in a descriptive manner, the times with and without ISS were compared using the t-test and the Pearson's correlation was employed in order to correlate the ISS thickness with the facial measurements (5% significance). Results: A statistically significant difference was found only for the variables of the lip area (p= 0.01) and Ls-Li (p=0.006) in comparison with/without ISS. No correlation was found between the ISS thickness and the lip area for both face sides, right (p=0.7; r=0.07) and left (p=0.9; r=-0.001). Conclusions: The use of interocclusal stabilization splint does not provide large changes in facial morphology, with the exception of the lip area and height.

A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder

Temporomandibular pain has multiple etiologies and a range of therapeutic options. In this pilot study, the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporomandibular disorders (TMDs). The authors assigned 80 participants randomly into one of the following four groups, all of which included a comprehensive self-care program: reversible interocclusal splint therapy (RIST), Activator Method Chiropractic Technique (AMCT) (Activator Methods International, Phoenix), sham AMCT and self-care only. They made assessments at baseline and at month 2 and month 6, including use of the Research Diagnostic Criteria for Temporomandibular Disorders. The authors screened 721 potential participants and enrolled 80 people; 52 participants completed the six-month assessment. The adjusted mean change in current pain over six months, as assessed on the 11-point numerical rating scale, was 2.0 (95 percent confidence interval, 1.1-3.0) for RIST, 1.7 (0.9-2.5) for self-care only, 1.5 (0.7-2.4) for AMCT and 1.6 (0.7-2.5) for sham AMCT. The authors also assessed bothersomeness and functionality. The authors found the study design and methodology to be manageable. They gained substantial knowledge to aid in conducting a larger study. AMCT, RIST and self-care should be evaluated in a future comparative effectiveness study. This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD.

Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching

The extent of separation between the maxillary and mandibular teeth in the fabrication of interocclusal splints designed to achieve efficiency and muscle relaxation is controversial and undefined in the literature. Based on this premise, the aim of this study was to evaluate the effect of interocclusal splint thicknesses of 3 and 6 millimeters on the electrical activity of the anterior temporal and masseter muscles during rest and dental clenching. Twenty asymptomatic individuals (10 males and 10 females) were selected using the Research Diagnostic Criteria (RDC). Electromyography (EMG) was performed both with and without the 3- and 6-mm splints using the Bio EMG software package, which recorded values given in microvolts (µV). The results, which were assessed using analysis of variance (ANOVA) to a 5% significance level (p < 0.05), showed increased electrical activity of the masticatory muscles during dental clenching compared with at rest, with greater activity in the masseter muscle. The electrical activity did not differ according to the thickness of the splints or between males and females. We can conclude that both splint thicknesses are effective in treating muscle hyperactivity given their similar clinical behavior for asymptomatic individuals.