Mouthguard Research Articles

Outcome of Screening Questions for Temporomandibular Disorders and Related Treatment in Adult Patients Attending the Public Dental Service.

Approximately 30% of the adult population experiences symptoms under the concept of temporomandibular disorder (TMD). To identify patients with TMD who may require further evaluation, three screening questions (3Q/TMD) have been introduced. The aim of this study was to explore the prevalence of self-reported TMD and the amount of treatment received by patients in the Public Dental Service in Stockholm and how many were referred to an orofacial pain specialist. Health declarations from 402 012 patients 18 and older were included. Answers to the 3Q/TMD, gender, performed treatment, and referrals were extracted from the patients' records. The prevalence of affirmative answers to 3Q/TMD was 4.6% and higher in the 20-29 age group compared to the 60-69 group. Affirmative answers in general led to more treatment, and an affirmative answer to Q1 gave the highest probability of treatment (OR 5.13; 4.87, 5.41) with occlusal splint therapy being the most common. Age did not significantly predicting the amount of treatment (p = 0.05), although there was a tendency towards less treatment in older age groups. In total, 0.74% of the study population were referred to an orofacial pain specialist, with a higher probability of referral for those who answered affirmatively (p < 0.001). The prevalence of self-reported TMD among patients in the Public Dental Service aligns with findings from similar studies. Patients who answered affirmatively to one or more of the screening questions were more likely to receive treatment or a referral. The 3Q/TMD effectively identifies patients who may benefit from further evaluation and referral, although the rate of treatment remains low.

Effectiveness of Occlusal Splints in the Management of Temporomandibular Disorders: Comparisons of Treatment Approaches and Digital Versus Conventional Fabrication Techniques.

This research explores the types and effectiveness of occlusal splints in managing temporomandibular disorders (TMDs). TMDs encompass a range of musculoskeletal and neuromuscular conditions affecting the jaw, causing pain, limited movement, and discomfort. Occlusal splints, also known as bite guards, are commonly used in dentistry to alleviate TMD symptoms by relaxing jaw muscles, preventing joint trauma, and protecting teeth. This research examines various splint types, including stabilization splints, anterior bite planes, and repositioning appliances, and analyzes their fabrication methods, indications, and contraindications. Additionally, it investigates the effectiveness of splint therapy in reducing pain, improving jaw function, and managing specific TMD conditions. The research also delves into the comparison of conventional, milled, and 3D-printed splints, considering their accuracy, fabrication time, cost-effectiveness, and patient satisfaction. Finally, it addresses potential complications associated with splint use and concludes by emphasizing the importance of occlusal splint therapy as a noninvasive and effective treatment option for TMD management.

Residual TPO Content of Photopolymerized Additively Manufactured Dental Occlusal Splint Materials.

Background/Objectives: Diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) is widely used in the dental industry as a photoinitiator for resin-based materials, while its use may be further limited given its toxicological risks. The aim of this study was, therefore, to analyze the residual TPO content of 3D-printed resin-based dental splint materials. Methods: Six resin-based splint materials were analyzed: LuxaPrint Ortho Plus (DMG), FREEPRINT splint 2.0 (Detax), optiprint splint (Dentona), KeySplint Soft (KeyPrint), FREEPRINT ortho (Detax), V-Print splint comfort (Voco). Grid-shaped specimens were fabricated using the recommended workflow of each manufacturer (n = 18). TPO extraction was conducted using a maximum of eight extraction cycles of 72 h at a temperature of 37 °C until no more TPO eluates were detected by high-performance liquid chromatography (HPLC). The margin of safety (MoS) was calculated as the ratio between the Derived No-Effect Level (DNEL) and the estimated exposure based on the amount of TPO extracted. Results: The total amount of extracted TPO was the lowest for LuxaPrint Ortho Plus (Mean ± SD; 44.0 ± 17.1 ng/mL), followed by optiprint splint (80.6 ± 21.1 ng/mL), FREEPRINT splint 2.0 (127.4 ± 25.3 ng/mL), FREEPRINT ortho (2813.2 ± 348.0 ng/mL), V-Print splint comfort (33,424.6 ± 8357.9 ng/mL) and KeySplint Soft (42,083.5 ± 3175.2 ng/mL). For all tested materials, the calculated MoS was above the critical value of 1, demonstrating toxicological safety in the cured, clinically relevant state. Conclusions: Large differences in the residual TPO content were observed between the materials. Although the TPO content in the uncured state may exceed toxicological safety limits, appropriate curing of the investigated materials resulted in a significant reduction in TPO elution and, thus, in products with a very low toxicological risk for the patient.

Comparison of Modified Occlusal Splint, Standard Splint Protocol, and Conventional Physical Therapy in Management of Temporomandibular Joint Disc Displacement with Reduction and Intermittent Locking: A Randomized Controlled Trial

Background: Temporomandibular joint disc displacement with reduction is one of the most common types of TMJ arthropathy. This single-blinded, randomized clinical study aimed to evaluate the effectiveness of three different therapeutic methods. Methods: Standard splints (Group 1), modified occlusal splint (Group 2), and conventional physical therapy with exercises (Group 3). A total of 48 patients were randomly assigned by a computer-generated allocation sequence to receive rehabilitation. The outcome was defined as improvements in pain and intermittent locking episodes. The follow-up visits were scheduled as one month and a long-term evaluation at one (T1), two (T2), three (T3), and four years (T4). Magnetic resonance images were also taken to evaluate each patient before treatment and at one year. Image analysis involved the evaluation of morphology and the function of intra-articular structures. Variables such as age, gender, and pre- vs. post-treatment values of VAS and TMJ locks between the three intervention categories were compared for statistical evaluations. p values ≤ 0.05 were taken as being significant. Results: A total of 16 subjects were allocated to each group. At T1, a decrease in pain and TMJ locking episodes was observed, which was maintained throughout the course of the study for four years of follow-ups, with no statistically significant differences. However, there was a tendency for better outcomes in favor of Group 2, with less clicking of the TMJ at opening. Conclusions: The modified mandibular splint seems to be successful as an effective alternative for the management of temporomandibular joint disc displacement with reductions in intermittent locking.

Comprehensive Review of Temporomandibular Joint Disorders: Insights into Occlusal Splint Therapy, CBCT Diagnostics, and Upper Airway Dimensions

Comprehensive Review of Temporomandibular Joint Disorders: Insights into Occlusal Splint Therapy, CBCT Diagnostics, and Upper Airway Dimensions

Pain Relief and Efficacy of Surgical vs Nonsurgical Management of TMJ Disorders: A Systematic Review

ABSTRACT Temporomandibular disorders (TMDs) affect the jaw muscles and joints, with treatments ranging from surgery to nonsurgical methods like physiotherapy and medication. A systematic review of studies from January 2020 to May 2024 compared these treatments’ effectiveness in relieving pain and improving function. From 7,459 initial records, 18 studies were included, examining interventions like NSAIDs, low-level laser therapy, botulinum toxin A, and occlusal splints. Results varied, highlighting the need for personalized treatment and standardized outcomes to improve patient care.

THE IMPACT OF STRESS DURING THE COVID-19 PANDEMIC ON THE DENTAL HEALTH OF MU-VARNA EMPLOYEES

Introduction: One of the negative manifestations of stress and anxiety related to dental health is the unconscious clenching or grinding of teeth, which gradually leads to tooth wear. Aim: The aim of this article is to determine the impact of the COVID-19 pandemic on the dental health of MU-Varna employees, to follow up on the therapeutic effect of wearing a bruxism mouthguard, and for the results to be applied in preparing a model for health promotion based on a multidisciplinary approach. Materials and Methods: From July 2022 to now, 995 patients have been examined, and 40 of them, university lecturers and administrative staff at MU-Varna, Bulgaria, have been prescribed a bruxism mouthguard. The following instruments were used: a unified form for defining the dental status and a survey about the therapeutic effect of the bruxism mouthguard. Results and Discussion: A voluntary, anonymous survey was conducted among MU-Varna employees in October 2023. The SPSS (version 22) software was used to process the data from the survey. The assessment of the therapeutic effect of the mouth guard was based on the results from the secondary exam at the clinician’s office and those from the conducted individual survey among the people wearing mouth guards for a specified period of time. Conclusion: The analysis indicates that the employees have a positive attitude toward wearing the mouthguard in the future. Its use helped decrease the frequency of conditions such as affect, anxiety, and quick tiredness.

Hybrid security in Nigeria–Benin borderlands: Formal and informal security actors’ collaboration and implication for cross-border security (2010–2023)

ABSTRACT In the borderland of Nigeria and the Republic of Benin there are both formal and informal security actors operating to curb trans-border crimes that extant literature is yet to adequately consider. Most empirical studies on the relations between security actors have largely focused on the nature of relations between formal security agencies and the implications of their relations for border security governance. This study fills the gap in the knowledge by investigating the nature of relations between formal and informal security actors. Utilising mixed-method research design and drawing on primary and secondary sources of data, the study contends that non-states security actors of different nomenclature such as Kelebe, Smugglers Association, Night Guards and Aja Custom, Social Safety Orientation Corps (So Safe Corps) exist in the borderland areas of Seme and Idi Iroko between Nigeria and the Republic of Benin. It is also argued that functional, dynamic and interest-based cordial relations between state and non-state security actors significantly contribute to curbing smuggling, drug trafficking, illegal migration with the exception of human trafficking. Thus, the study recommends that the Nigerian government should re-organise the border security order to include non-state security actors in the governance of borders between Nigeria and the Republic of Benin.

Accuracy of occlusal splints printed in different orientations by liquid crystal display technology: an in vitro study

ObjectivesTo evaluate the accuracy of occlusal splints printed in different orientations by liquid crystal display technology. MethodsAn occlusal splint was digitally designed, and additively manufactured using an LCD printer (Phrozen Sonic 4k, Phrozen) at three orientations relative to the printer building plate: 0, 45, and 70 degrees (n=10). The 3D-printed occlusal splints were digitised using a desktop scanner, resulting in experimental meshes. The meshes were analysed in a metrology software program, comparing the experimental ones with the initially designed occlusal splint (trueness) and each other within the same group (precision). The discrepancies were shown in a colour map and the root mean square indicated the magnitude of the total discrepancy between the meshes. Kruskal-Wallis test was used (α=0.05) followed by post-hoc Dunn's test. ResultsThere was no statistical difference in trueness among the groups (P=0.086); however, splints printed at 70 degrees showed better precision compared to those printed at 0 (P<0.001) and 45 degrees (P<0.001). The splints printed at 0 and 45 degrees exhibited a similar discrepancy pattern, with highest values concentrated in the posterior segment—positive on the buccal surface and negative on the lingual surface of molars. In contrast, splints printed at 70 degrees had highest discrepancy values in both anterior and posterior segments, with an inverted pattern on molars. Conclusion: The accuracy of occlusal splints was affected by the different orientation in terms of precision, with 70 degrees resulted in highest precision compared to 0 and 45 degrees. No difference was found in terms of trueness. Higher discrepancies were found located in molars and incisal edge of anterior teeth. Clinical significance3D-printing using LCD technology stands out for its affordability and good resolution, however the optimal printing angle remains unclear. Vertical positioning allows more objects to fit on the printer building plate, while horizontal positioning reduces print time. According to literature, for DLP printers, a 0-degree angle provides good accuracy for occlusal splints, whereas a 90-degree angle results in lower accuracy. This study found that for LCD printers, 0, 45, and 70 degrees had similar trueness, with 70 degrees offering the highest precision. Thus, vertical positioning at 70 degrees can be a safe choice for the accuracy of occlusal splints printed on LCD technology.

A clinical case of treatment of temporomandibular joints disease caused by occlusive disorders

A method of treatment,described in this clinicalcase, isaimedateliminatingdisorders of occlusalrelationships of the dentition, (PatentNo.2797641dated06/07/2023) contributing to the normalization of TMJ functioning. At the first stage of treatment, a repositioning occlusal splint was used, applied to all teeth of the lower jaw, which was being corrected for six months. This stage was considered completed on the basis of the following criteria: absence of the patient`s complaints and smooth movements of the mandible without deviations and clicks on objective examination, as well as formation of symmetrical graphs of the TMJ condyles movement on axiographic examination, an optimal location of the TMJ condyles on sagittal projections of MSCT and positive changes in the bioelectric activity of the masticatory muscles, towards higher and more symmetrical values on both sides. Further treatment was carried out by an orthodontist with a non-removable technique,using a brace system. Wearing of the occlusal splint continued until the braces system was put on the teeth of the lowerjaw. It was then replaced by composite liningsin the projection of the firstmolars of the upperjaw. Dynamicmonitoring of thepatientforhalf ayearafter the end of the treatment indicated remission of TMJ disease. Normalization of occlusal relationships of dentitions in intact dentitions and small defects through splint therapy followed by the use of a brace systemis a minimally invasive andeffectivemethod of treatment TMJ diseases.

Occlusal splint or botulinum toxin-a for jaw muscle pain treatment in probable sleep bruxism: A randomized controlled trial

ObjectivesTo conduct an equivalency randomized controlled trial comparing occlusal splint (OS) and botulinum toxin-A (BTX-A) on jaw muscle pain in probable sleep bruxism. MethodsSixty patients (≥18 years, probable sleep bruxism, and jaw muscle pain) were randomly allocated into groups. The primary outcome was the reduction of jaw muscle pain, assessed using the Graded Chronic Pain Scale (GCPS, v2.0). Secondary outcomes included: parameters of jaw opening and mandibular mobility; distribution of muscle pain; Jaw Functional Limitation Scale–20 (JFLS-20), Oral Behaviors Checklist (OBC); and Oral Health Impact Profile-14 (OHIP-14). Only the evaluator was blinded. Multilevel mixed-effects regression models were used. ResultsFifty-nine patients (30 received OS and 29 BTX-A) were analyzed at baseline, 3 and 6 months follow-up. One patient dropped out after receiving the intervention. No differences between the interventions were observed concerning the GCPS (p = 0.627), although a significant reduction was observed at 3 (OR=13.26, 95%CI[6.61–26.59]) and 6 months (OR=12.36, 95%CI[4.93–30.98]), regardless of the treatment. BTX-A showed a lower score reduction on JFLS-20 than OS (OR=0.29, 95%CI[0.11–0.82]). BTX-A presented inferior results for the parameters: opening without pain(p = 0.045), unassisted maximum opening(p = 0.024), assisted maximum opening(p = 0.041), and protrusion(p = 0.016). An improvement in OHIP-14 scores was observed at 3 (IRR=1.08, CI95%[1.02–1.14]) and 6 months (IRR=1.10, CI95%[1.04–1.16]), regardless of the intervention. BTX-A participants(n = 23;79,3%) reported mild discomfort during chewing. ConclusionOS and BTX-A can effectively decrease the GCPS scores, improve OHRQoL, and enhance functional outcomes in sleep bruxist patients with jaw muscle pain. OS demonstrated slight advantages in specific parameters. Clinical SignificanceBoth occlusal splints and botulinum toxin-A effectively reduce jaw muscle pain in bruxist patients, improving quality of life and mandibular function. Clinically, occlusal splints may offer additional benefits in specific functional parameters. (NCT03456154)

Optimizing the treatment of patients with intrinsic temporomandibular joint disorders

Temporomandibular joint (TMJ) dysfunctions are conditions in which there is a disruption in the anatomical and functional relationship between the various structures of the joint, including the articular disc, intra-articular ligaments, mandibular head and capsule. These disorders have a negative impact on the patient’s quality of life, resulting in limitations in masticatory function and articulation. The multifactorial nature of this pathology emphasizes the need for an individualized and comprehensive approach to the treatment of each patient. In most cases, treatment includes both surgical and orthopedic methods. Currently, combined treatment approaches aimed at synergistic effects are being actively developed to maximize therapeutic Results.The purpose of this study. To evaluate the efficacy of the combination of treatment with a repositioning mouthguard and the use of the hydraulic articular disk repositioning method in patients with internal TMJ disorders combined with dental row end defects.Materials and methods. The study included 6 patients with TMJ dysfunction and end defects of the dentition. The study was conducted between September 2023 and May 2024. As part of the study, each patient underwent cone beam computed tomography (CBCT) to evaluate the bony structures of the TMJ and ultrasound (US) to evaluate the soft tissue structures of this joint.Results. The CBCT data showed that the mean posterior temporomandibular joint displacement before treatment was 1.67, while this value increased to 3.02 after treatment. The US results showed a significant decrease in the mean value of mandibular head displacement after treatment ranging from 0.21 to 0.03, indicating a positive effect of treatment. In addition, there was a decrease in the difference in the size of the anterior and posterior parts of the articular disc, confirming the elimination of its displacement.Conclusion. The treatment combination of using a repositioning mouth guard with the hydraulic repositioning method brought about a synergistic effect on the restoration of TMJ function.

Manual Therapy Techniques Versus Occlusal Splint Therapy for Temporomandibular Disorders: A Systematic Review with Meta-Analysis.

Background: Manual therapy (MT) and occlusal splint therapy (OST) are the most conservative therapies applied on patients with temporomandibular disorders (TMDs). The aim was to compare the efficacy of MT vs. OST in improving pain, maximal mouth opening (MMO), disability, and health related-quality of life (hr-QoL) in these patients. Methods: According to PRISMA guidelines, a meta-analysis (CRD42022343915) was conducted including randomized controlled trials comparing the effectiveness of MT vs. OST in TMD patients, after searching in PubMed, PEDro, SCOPUS, and WOS up to March 2024. Methodological quality and risk of bias were assessed using the PEDro Scale. Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) were the pooled effect measures calculated. Results: Nine studies, providing data from 426 patients, were included. Meta-analyses revealed that MT is more effective than OST in reducing disability (SMD = -0.81; 95% CI -1.1 to -0.54) and increasing MMO (SMD = 0.52; 95% CI 0.27 to 0.76) without differences for improving pain intensity and hr-QoL. Subgroup analyses revealed the major efficacy of OST in reducing pain in myogenic patients (SMD = 0.65; 95% CI 0.02 to 1.28). Conclusions: With caution, due to the low number of studies included, MT may be more effective than OST for improving disability and MMO in patients with TMDs.

Comparison of Compression of Occlusal Splint Materials: Laboratory Mechanical Analysis

Objective: To perform a compression test to fill the gap in the literature, assess the change in the construction angle (0º, 45º, 90º) as well as investigate physical and microstructural characteristics. Theoretical Framework: Comparisons of compression tests of occlusal splint materials printed in 3D are not described in the literature, which makes informed decision making on the choice of materials complicated. Method: The materials printed in 3D using the SLA method were resins. After printing, the materials were submitted to compression (calculating the Poisson coefficient), shore hardness and density tests. Results and Discussion: Dima® Print Ortho achieved the best results in terms of compression strength and maximum deformation in the vertical position (90º) in comparison to the other materials, followed by Self BioPrint Splint Hard, PriZma 3D Bio Splint and Cosmos Splint. Research Implications: Three-dimensional devices through additive fabrication can be used in the treatment of bruxism. The position to obtain greater compression strength is vertically at 90º. Originality/Value: This study contributes to the literature by demonstrating the efficacy of 3D printing of occlusal devices using the resin polymerization method, highlighting the superior dimensional accuracy and mechanical properties of the materials employed. Furthermore, it addresses the sustainability of the process by promoting material waste reduction during fabrication. These findings have significant implications for optimizing the production of occlusal devices in clinical settings.

Understanding the clinical management of co-occurring sleep-related bruxism and obstructive sleep apnea in adults: A narrative and critical review.

Sleep-related bruxism (SRB) is a motor oral behavior characterized by tooth grinding and jaw clenching activity, reported by 8%-12% of the adult general population and 3% of older individuals. The frequency of one of its biomarkers, rhythmic masticatory muscle activity (RMMA), remains elevated across ages. Obstructive sleep apnea (OSA) is associated with the brief and repetitive pause of breathing (apnea) and with transient reduction in oxygen (hypoxia). OSA is observed at all ages and in about 50% of older individuals with a male preponderance. SRB clinical assessment is based on self-reporting of tooth grinding sound, awareness of clenching, jaw pain or headache, and clinical observation of tooth damage. OSA clinical assessment is based on sleepiness and fatigue, snoring, sleep quality, and awareness of breathing cessation, plus clinical examination of anatomical factors (e.g., obesity, retrognathia, large tonsil, macroglossia), age, gender, and body mass. Although the literature does not support association or causality between these two conditions, the co-occurrence is reported in about 30%-50% of adults. To confirm a diagnosis of co-occurring SRB and OSA, home sleep testing (HST) may be indicated. A sleep test is performed using electromyography (EMG) of jaw muscle (masseter or temporalis) and cardio-respiratory variables (e.g., air flow, respiratory effort, oxygen level, heart rate). The management of co-occurring SRB and OSA for individuals with prosthodontic needs is challenging to prevent compromising the oro-pharyngeal space and breathing efficiency. OSA treatment in the presence of SRB includes continuous positive airway pressure (CPAP) use alone or with an occlusal splint or mandibular advancement device (MAD). In addition, the following may be considered: supine sleep correction device, myofuncional therapy, medications, and surgeries. All have limitations and risks. Individual variability suggests that phenotyping is mandatory to select the most efficient and personalized treatment.

Assessment of parental attitude, knowledge and awareness towards preventive dentistry in south zone of Chhatrapati Sambhajinagar: A questionnaire based cross sectional survey

Introduction: Oral health is a pivotal aspect of overall well-being. In early childhood, primary teeth play a vital role in development of speech, chewing, maintaining proper spacing, and guiding the eruption of permanent teeth. Common oral conditions comprise dental caries, malocclusion, childhood caries, and trauma. Aim: The present study was conducted to assess paternal knowledge towards the forestallment of oral conditions and application of preventive dental procedures in children in South zone of Chhatrapati Sambhajinagar. Materials and Methods: A cross-sectional questionnaire was administered to parents of pediatric patients of age group 3 to12 years in South zone of Chhatrapati Sambhajinagar, Maharashtra, with a sample size of 270 participants. A structured questionnaire, comprising 14 questions in English, was developed, translated and back translated into the local language Marathi by experts to ensure better comprehension by the parents. The questionnaire was divided into two sections: the first focused on demographic information, while the second included 14 multiple-choice, close-ended questions. These questions included topics such as preventive treatments for dental caries, childhood caries, topical fluoride application, fluoridated toothpaste, pit and fissure sealants, habit-breaking dental appliances, malocclusion, mouth guards, and space maintainers. Additionally, the survey addressed harmful habits such as thumb-sucking, tongue-thrusting, and nail-biting. Result: 56.6% of parents sought dental care only after experiencing pain. Additionally, parents of paediatric patients have restricted knowledge about preventive dentistry. Conclusion: Parental knowledge about preventive dental procedures is limited, as is the utilization of these measures.

Influence of 3D printing system, postpolymerization and aging protocols on resin flexural strength and dimensional stability for printing occlusal splints, models and temporary restorations.

Investigate the effect of different postpolymerization protocols, aging, and 3D printing systems on the flexural strength (σ), dimensional stability, and roughness of resins used to fabricate occlusal splints, dental models, and temporary restorations. 180 bars (25 × 2 x 2mm-ISO 4049) of each type of resin (T-Temporary/Cosmos Temp, Yller; OS-Occlusal splint/Cosmos Splint, Yller; MO - Models/ Cosmos Model, Yller) were printed and divided into 12 groups (n = 15) according to the factors: "Postpolymerization" (Ctr - Control; UV - Ultraviolet oven and MW - Microwave); "Printer" (SLA- stereolithography (Forms 2/Formslab); LCD- liquid crystal display (FlashForge Foto 6.0/FlashForge)) and "Aging" (TC - 10,000 thermocycling cycles and Without). Each bar was measured with a digital caliper at 11 points before and after postpolymerization to evaluate dimensional stability. The samples were subjected to the σ test (100Kgf;1mm/min). Data was evaluated using Three- and Two-way ANOVA, and Tukey's test (5%). Weibull analysis, Scanning Electron Microscopic and optical profilometry was performed. LCD printing system and UV oven postpolymerization exhibited the highest σ (P < .05). The groups printed in SLA and post-polymerized in microwave ovens showed the greatest variations in their dimensions, for the occlusal splint resin, the OS-SLA-MW group (-4.29 ± 3.15)A showed a shrinkage of 40.2%. The resins for models (3.31 ± 0.66)A and temporary (-2.06 ± 1.52)A showed a shrinkage of 33% and 20.6%, respectively. LCD printing with UV light postpolymerization was the most effective method for resins used in occlusal splints, dental models, and temporary restorations. SLA printing with UV postpolymerization showed the most significant dimensional changes, leading to shrinkage in occlusal splint resins, while model resins and temporary restorations expanded. Resins for 3D printing should ideally be post-polymerized with UV light and printed using LCD technology, as this approach results in better mechanical properties and less dimensional change compared to microwave oven post-polymerization.

Pain Catastrophizing and Functional Activation During Occlusion in TMD Patients-An Interventional Study.

In temporomandibular disorder (TMD), the effects of standard interventions such as using an occlusal splint and its impact on pain relief and pain catastrophizing are poorly understood. Earlier work pointed to a crucial role of insula activation with changes in pain relief by occlusal splint treatment. We performed a functional imaging study using specially developed splint systems to allow for a placebo-controlled longitudinal design. Using functional MRI we examined 20 TMD patients during repetitive occlusal movements at baseline and over the course of splint therapy and also collected self-reported pain catastrophizing. For balancing performance between baseline and after intervention we used occlusion force measures in an individualized fMRI-splint system. Splint therapy lasted for approximately 7 weeks with one group selected by randomization wearing a palatine placebo splint over the first 3 weeks (delayed start; 11 individuals). As expected, fMRI activation in areas involved in pain processing (insula, primary and secondary somatosensory cortex) decreased with intervention. At baseline a positive correlation between activation of the left anterior insula and pain catastrophizing was present. Both parameters decreased over intervention while associations were primarily observable for patients with rather mild TMD.

Efficacy of added splint therapy after arthrocentesis vs arthrocentesis alone in the management of temporomandibular joint disorders: a systematic review and meta-analysis.

Occlusal splints are commonly used in the management of temporomandibular joint (TMJ) disorders (TMD). However, it is unclear if it should be used after a second-line therapy like arthrocentesis. We systematically reviewed the evidence on the efficacy of post-arthrocentesis splint therapy in the management of TMD. PubMed, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were searched for studies published until 5th August 2024. The outcomes assessed were pain and maximal mouth opening (MMO). Eight studies were included. Five studies reported data for the meta-analysis. The pooled analysis found that there was no statistically significant difference in pain scores in the arthrocentesis &#43; splint group vs arthrocentesis group at 1 month (MD: -0.01 95% CI: -0.46, 0.44), 3 months (MD: -0.02 95% CI: -0.67, 0.63) and 6 months (MD: 0.06 95% CI: -0.25, 0.37). The pooled analysis also showed that splint therapy after arthrocentesis may not significantly improve MMO as compared to no splint therapy at 1 month (MD: 0.08 95% CI: -2.11, 2.27), 3 months (MD: 0.76 95% CI: -0.84, 2.35) and 6 months (MD: 0.56 95% CI: -0.65, 1.78). Descriptive analysis of three studies showed that two supported the use of splints while one found no added improvement in outcomes. Limited evidence from low-quality studies shows that the use of splint therapy after arthrocentesis may not improve pain and MMO in patients with TMD. High-quality randomized controlled trials are needed to improve evidence.

Temporomandibular joint space variation and masticatory muscle activation during clenching with full versus partial covering occlusal splints

ObjectivesOcclusal splints are the main therapeutic choice in the treatment of temporomandibular disorders (TMD). However, their precise working mechanism is unclear. This study aimed to compare the biomechanical effect of three commercially available splint designs (full covering splint, anterior bite splint and posterior bite splint) during biting in a sample of healthy subjects.Materials and methodsMagnetic resonance imaging (MRI) was combined with jaw tracking to measure the minimal intraarticular distance (MID) of 20 human temporomandibular joints (TMJ) whilst simultaneously recording the electromyogram (EMG) of the masticatory muscles. The changes caused by clenching with a bite force of 100 N without splint (baseline) and on each splint were calculated. Repeated measures ANOVA was performed on the means of the MID variations and EMG amplitudes.ResultsClenching on the anterior bite splint resulted in two times less activation of the anterior temporalis muscle than baseline (p = 0.003), full covering (p = 0.011) and posterior bite splint (p = 0.011). MID was reduced by clenching in all conditions, but the reduction was almost three times larger with the anterior bite splint compared to no splint (p = 0.011). The full covering splint and the posterior bite splint did not differ significantly in EMG activation of both masseter and temporalis muscles and MID variation.ConclusionsThis study showed that splint designs have a different impact on the MID and EMG activation while clenching. The anterior bite splint had a greater impact on the reduction of the muscle activation, whereas clenching on the anterior bite splint led to bigger reduction of MID and thus had the greatest influence on alteration in the condylar position.Clinical relevanceThe design of the splint can affect MID and muscle activation and is a variable to consider in the treatment of patients with TMD according to their symptoms.