Soft Occlusal 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.

Case Report: Management of self-injurious habit in a pediatric patient using soft splint

Mouth ulcer is a common clinical manifestation of the oral cavity that occurs in the oral mucosa and is usually associated with a variety of causes and diseases. This type of habitual injury in children is transient and tends to worsen over time. Various treatment options have been implemented, therefore in this case, the treatment of cheek biting was performed using palliative therapy in conjunction with a soft occlusal splint in a 9-year-old child. The treatment plan involved a soft occlusal splint along with antibiotic coverage and multivitamin therapy. After 1 month follow-up complete healing of the ulcer was seen. This case presented a conservative treatment approach for repeated cheek biting without harm to the tooth structure. Early detection of lesions and identification of risk factors allows for a more conservative clinical approach. It is preferable to rule out the cause behind the lesion and accordingly plan the treatment which fits the patient's needs.

Effect of Hard and Soft Occlusal Splints on Electromyographic Activity of Masseter and Anterior Temporalis in Patients with Moderate to Severe Occlusal Wear: A Randomized Controlled Trial

Effect of Hard and Soft Occlusal Splints on Electromyographic Activity of Masseter and Anterior Temporalis in Patients with Moderate to Severe Occlusal Wear: A Randomized Controlled Trial

Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism

ObjectiveOcclusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion.MethodsSixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter.ResultsAt teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05).ConclusionModified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.

Effect of 3D Printer Type and Use of Protection Gas during Post-Curing on Some Physical Properties of Soft Occlusal Splint Material.

Despite the fact that three-dimensional (3D) printing is frequently used in the manufacturing of occlusal splints, the effects of the 3D printer type and post-curing methods are still unclear. The aim of this study was to investigate the effect of the printer type (digital light processing: DLP; and liquid crystal display: LCD) as well as the post-curing method with two different atmospheric conditions (air and nitrogen gas (N2)) on the mechanical and surface properties of 3D-printed soft-type occlusal splint material. The evaluated properties were flexural strength, flexural modulus, Vickers hardness (VHN), fracture toughness, degree of double bond conversion (DC%), water sorption, water solubility, and 3D microlayer structure. The printer type significantly affected all the evaluated properties. Flexural strength, flexural modulus, and fracture toughness were significantly higher when specimens were printed by a DLP printer, while VHN and DC% were significantly higher, and a smoother surface was noticeably obtained when printed by an LCD printer. The post-curing at an N2 atmosphere significantly enhanced all of the evaluated properties except water sorption, 3D microlayer structure, and fracture toughness. The current results suggested that the printer type and the post-curing methods would have an impact on the mechanical and surface properties of the evaluated material.

A Comparison of Hard and Soft Occlusal Splints for the Treatment of Nocturnal Bruxism in Children Using the BiteSTRIP®.

Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the effectiveness of occlusal splint treatments in children with nocturnal bruxism using the BiteStrip®. The muscle activity of children was measured using the BiteStrip®. The groups used occlusal splints during nighttime sleep for three months, at the end of which their muscle activity were measured again through the use of the BiteStrip®. Muscle pain in palpation and pain in the dynamic position of TMJ pain was significantly reduced in patients using soft occlusal splint (p=0.01). There was no significant change in the BiteStrip® score in both group I (p=0.11) and group II (p=0.61). Soft occlusal splints could reduce pain caused by nocturnal bruxism on muscle and TMJ. The relationship between treatment results and BiteStrip® scores of patients using soft occlusal splint or hard occlusal splint are not significantly.

Efficacy of Customized Soft Occlusal Splints in the Management of Temporomandibular Joint Disorders among the Population of Parsa District of Nepal

Background: In recent years, temporomandibular joint disorders (TMDs) have been a highly debated topic. TMD is the collective term of clinical problems that involves the masticatory apparatus, temporomandibular joint (TMJ), and its associated structures or both. It is really a tough challenge for both the dental and the medical specialists and is often difficult to diagnose and treat such a disorder as the presenting symptoms can be variable. A variety of treatment modalities have been described in the literature for its management and the conservative method is most preferred. The objective of the present study was to evaluate the effectiveness of soft occlusal splint therapy among the population of Parsa district of Nepal in the management of TMDs. Materials and Methods: Thirty subjects with signs and symptoms of TMDs were included in the study, out of which 13 (43.3%) subjects were males and 17 (56.7%) were females, with age ranging from 21 to 40 years. Soft occlusal splints were given to the patients for about 3 months and evaluated for reduced mouth opening, tenderness of TMJ (preauricular), TMJ sounds, and mandibular deviation after 1 week of initiation of therapy and every month for 3 consecutive months. Results: There was a significant improvement of 3.06 mm (9.7%) in mouth opening, 86.7% of subjects showed significant reduction in preauricular tenderness, 80.0% subjects showed reduction in TMJ sounds, and 76.7% of subjects showed improvement in mandibular deviation after 3 months of the splint therapy. Paired t-test and Chi-square tests were done for comparison. Conclusions: Soft occlusal splints can be used effectively as a conservative treatment modality in reducing the signs and symptoms related to TMDs.

Dysfonctionnement de l’appareil manducateur

Contact loss between the articular disc and the TMJ mandibular condyle, and the excessive stress on lateral pterygoid muscles can lead to temporo-mandibular dysfunction (TMD) in roughly 5% of people (twice more often in females). The TMD syndrome is a mix of pain and cliking arising from temporo-mandibular joint, sometimes associated with otalgia or tinnitus, and regional hypersensitivity, with myo-fascial pain of neighbouring muscles (masseter, temporalis, and sometimes sternocleidomastoid, scalenus, trapezus). Main symptoms are TM pain, often combined with cervicalgia and temporal and occipital headaches. Tinnitus and otalgia can also be found and are suggestive of the diagnosis when they occur during mouth opening. Pain in the throat and the face can also be noticed. A tenderness of the temporo-mandibular joint, an audible “click”, and an asymmetrical opening of the mouth, reduced to less than three fingers, are main findings. Several underlying disorders must be searched for: (1) malocclusion, sometimes induced by orthodontics treatments; (2) inappropriate dental prosthesis; (3) maxillo-mandibular dysmorphosis; (4) abnormal deglutition with tongue interposition during the 2500 oral stages of swallowing, so that speech therapist advice can be welcome; (5) cervical scoliosis and asymmetrical hearing or sight can worsen myofascial syndromes; (6) stress and fibromyalgia can coexist but are not the main source of TMD. Occlusal treatment, physiotherapy, cognitive-behavorial treatment seem the most useful treatments of this frustrating disorder, soft occlusal splint therapy being little effective.

Can hard and/or soft occlusal splints reduce the bite force transmitted to the teeth and temporomandibular joint discs? A finite element method analysis

ABSTRACT Objective To test whether two different materials used for occlusal splints would reduce the stress to the temporomandibular joint discs. Methods Geometric data from a young-adult male patient were obtained from computed tomography and magnetic resonance imaging. 3D biomodels and the finite element analyses were performed using specific software. Results The mandibular model presented the highest bone stress areas in the mandibular rami and insertion of the temporalis muscles. Regardless the material, the highest stress in the occlusal splints was located in the second molar regions on the occlusal splint surface and in the opposing mandibular second molars. Stress reduction was only observed in the internal surface of the occlusal splints embracing the maxillary teeth. No differences between occlusal splints were found in the stress intensity and distribution in either left or right TMJ discs, being concentrated more in the anterior portion of the disc. Discussion Hard acrylic OS should be preferred over soft EVA OS in the majority of cases, soft OS only for temporary use. Thinner OS (2–3 mm anterior thickness) should be preferred over thick ones (3–4 mm) in order to keep the stress concentrations in the center of the TMJ discs. Lighter contacts over heavier contacts should be preferred in the second molar OS contact surface area to prevent stress concentrations and fractures. Maxillary occlusal splints should be chosen if the teeth or implant are in the maxilla, and vice-versa.

The effect of occlusal splints on the mechanical stress on teeth as measured by intraoral sensors.

Whether it is possible to prevent mechanical stress on teeth via an occlusal splint remains to be clarified. This study aimed to assess the same by simultaneously recording the occlusal pressure and strain on the teeth in humans. Eleven participants (five women and six men; mean age 25.7 years) were enrolled in this study. Hard and soft oral appliances were fabricated for the maxillary arch of each participant. The strain on the four target teeth (right maxillary and mandibular first premolars, and first molars) and occlusal pressure were concurrently measured, while the participants performed maximum voluntary teeth clenching under each condition (hard, soft, or no occlusal splint). Compared to the absence of an occlusal splint, hard occlusal splints generated less strain on molar teeth but more strain on premolar teeth, while soft occlusal splints did not lower the strain on all target teeth significantly. Considering the limitations of this study, hard occlusal splints should be used for the protection of molar teeth but for premolar teeth caution is required and depends on the case. On the other hand, soft occlusal splints may not have any benefit for the protection of either type of teeth for patients exhibiting excessive occlusal pressure.

Evaluation of Oral Splint in Treatment of Tempromandibular Disorders in Class I Malocclusion

Objective: This study was designed to evaluate the effect of occlusal splints used for treatment of tempromandibular disorders (TMD). Material and methods: Thirty class I malocclusion patients (ranging in age 20-30) suffering from signs of TMD attending at orthodontic department, faculty of dental medicine, Al Azhar university boys branch. The patients' complaints were crowding of teeth, limited mouth opening, tempromandibular joints (TMJ) pains, and joint noises during function. The patients will be divided randomly into three groups. Group I will have patients treated by hard rigid occlusal splint (heat cured tooth borne and occlusal surface). Group II will have patients treated by soft occlusal splint flexible and pliable tooth borne and occlusal surface. Group III will have patients treated by dual laminated occlusal surface, hard acrylic resin and soft material on tooth borne surface. Clinical evaluation was performed before the delivery of the splint and at 2, 4, 6 months. Maximum mouth opening and joint sound were recorded each follow up visit. Results: All groups of the study showed improvement in maximal mouth opening, TMJ pain, and clicking sounds with variable degrees according to treatment method. Conclusion: Dual laminated occlusal splint seemed to be superior in achieving rapid and prolonged improvement in TMD patients than other splints.

Chewing muscles functional status assessment in patients with TMJ muscular-articular dysfunction while using of soft occlusal splint

Currently, the functional diagnosis of the entire dentition state is becoming an integral part of orthodontic and temporomandibular joint (TMJ) disorders correction. Aim — to study the functional state of the masticatory muscles in patients with muscular-articular dysfunction before and after using an soft occlusal splint. Materials and methods. A comprehensive examination of 478 patients (63% women, 37% men), aged 18 to 50 years, with various types of the dentition occlusion and muscular-articular TMJ dysfunction was performed. The main methods of functional diagnostics included: 1) masticatory muscle electromyography on Synapsis electromyograph (NeuroTech, Russia); 2) occlusion computer analysis with T-Scan III (Teksan, USA). Results. This work has established, based on the masticatory muscles functional state study, that bioelectrical activity was higher in the temporal muscles than in the masticatory muscles with the coefficient of symmetry from 2 to 4.5 in 65% of patients. After using an soft occlusal splintfor 6—12 months, the data of functional research methods confirm an improvement in the state of masticatory muscles in 84% of patients with TMJ. Conclusions. The obtained results have confirmed the fact of the masticatory muscles functional state improving with effectiveness of an soft occlusal splint use in patients with muscular articular TMJ dysfunction.

Present situation and future of occlusal splint in treatment of oral diseases

Occlusal splint is a removable device for the treatment of oral and maxillary diseases with reversible occlusal treatment property. When patients wear the occlusal splint, the occlusal contact state can be changed and the position of the lower jaw may be adjusted, with the improvement of functions of temporomandibular joints and masticatory muscles. There are various types of occlusal splints, among which stabilization splint, soft occlusal splint and repositioning splint are widely used in the treatment of temporomandibular disorders and night bruxism. For the patients requiring occlusal reconstruction, occlusal splint can be used as an important means to adjust and verify the therapeutic jaw position. As a major trend of research in future, the digital design and production of occlusal splint are still in the initial stage and need to be further improved.

Patient satisfaction with a postal service for occlusal splints

AbstractAimOcclusal splints are an effective intervention for temporomandibular disorders, and are often used in tooth wear, for protection of extensive adhesive restorations, and as a means of applying medications to gingival conditions. Patients may be required to attend a second appointment to fit the device after impressions are taken, however, some units may send the device in the post once constructed. These appliances rarely require modification to fit and are not occlusally adjusted. The aim of the present study was to assess patients’ satisfaction with a postal system for soft splints.Methods100 consecutive patients who had been issued with a soft occlusal splint by post immediately prior to August 2015 were sent a questionnaire assessing their satisfaction with receiving the splint in this manner.ResultsThe response rate was 42%. 93% of respondents reported that their splint fitted correctly and 98% reported that they had used it, with the mean length of wear being 8.7 weeks (SD: 5.7). 81% of patients reported that the splint helped “a lot” or “a little”. 83% of patients reported being “very happy” or “happy”, and 15% were “not bothered” about not seeing a clinician.ConclusionsOur results would suggest that patients are generally pleased with receiving a splint in the post. This system may allow reduced demand on services and may reduce out of pocket and time costs incurred to patients. The low response rate however may affect generalisability.

Preliminary clinical application of complete digital workflow of design and manufacturing occlusal splint for sleep bruxism

To establish a complete workflow of digital design and manufacturing occlusal splint for sleep bruxism, which can be preliminarily applied in clinical use, thus observe the clinical efficacy. Twenty-four patients with sleep bruxism were recruited in the study and randomly divided into two groups by using random number tables. Digital-occlusal-splint (experimental group) treatment plan and traditional-occlusal-splint (control-group) treatment plan were carried out for each group, respectively. For experimental group, digital models of patients' both dental arches and the occlusion relationship after elevation were captured using an intraoral scanner. The occlusal splint was carried out by computer aided design/computer aided manufacturing (CAD/CAM), including splint designing and milling. For control group, the traditional soft occlusal splint was fabricated by vacuum laminator. The two kinds of occlusal splints were tried in the patients from each group, and the occlusal contacts were tested respectively by T-scan analysis system, which recorded the changes of occlusal indicators in the two groups. The retention, appearance and occlusal comfort degree were evaluated by the two groups of patients. Mann-Whitney test was performed with IBM SPSS 20.0 software, and bilateral test was performed. P<0.05 was considered to be statistically significant. The complete workflow of digital design and manufacturing occlusal splint was successfully established. During the clinical use, there was no statistical difference in the retention evaluation of two kinds of occlusal splints between the two groups of patients (Z=-0.538, P=0.590). The appearance score (Z=2.038, P=0.042) and the occlusal comfort score (Z=-2.579, P=0.010) of the experimental group were higher than those of the control group, with statistically significant differences. The T-scan analysis results showed that only the second molar on both sides of the traditional occlusal splint had occlusal contact in intercupsal position, while the digital occlusal splint had stable and bilaterally balanced contact between the maxillary and mandibular teeth. Furthermore, the occlusal force was uniformly distributed in the experimental group. The complete workflow of digital occlusal splint improves the occlusal design, greatly simplifies and optimizes the traditional process of making occlusal splint. This new method is resource-saving and environmental-friendly, and it is able to serve patients more conveniently and efficiently.

Miseries and remedies of myofascial pain dysfunction syndrome: Comparative study

Background: Myofascial pain dysfunction syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies have been described in literature for its management. Objectives: This study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with transcutaneous electrical nerve stimulation (TENS) in the management of MPDS. Materials and Methods: Sixty patients who reported to the Department of Oral Medicine and Radiology, Pacific Dental College, Udaipur, since September 2009, in the age range of 17–55 years were included in the study and were randomly assigned to two equally sized groups, A and B. Group A patients received TENS therapy, whereas Group B patients received soft occlusal splint therapy. All the patients were evaluated for pain using visual analog scale (VAS), maximum comfortable mouth opening, temporomandibular joint (TMJ) clicking, and tenderness during rest and movement, as well as for the number of tender muscles at the time of diagnosis, after the first week of initiation of therapy, and every month for 3 months of follow-up. Results: There was a progressive decrease in VAS, number of tender muscles, TMJ clicking, and tenderness with various jaw movements, and there was a significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period when compared with TENS therapy group. Conclusion: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, has fewer side effects, and is more cost-effective than TENS therapy; hence, it can be chosen for the treatment of patients with MPDS.

Comparative Evaluation of Salivary Cortisol Levels in Bruxism Patients Before and After Using Soft Occlusal Splint: An in vivo Study.

Introduction:Bruxism is defined as a nonfunctional activity or a parafunctional habit characterized by the unconscious repetitive motion of clenching and/or grinding of the teeth. Soft occlusal splints have been considered as the first-line strategy for treating nocturnal bruxism. Cortisol is a major steroid hormone secreted by fascicular zone of the adrenal cortex, belonging to the glucocorticosteroidal group of hormones. Clinical studies have shown that when humans are placed under stress, the hypothalamic–pituitary–adrenocortical axis is activated, leading to an increase in cortical secretion. However, the effect of splint is questionable by some researchers, and best way to perceive the effect of soft splints in patients with bruxism is by evaluating the stress levels.Materials and Methods:A total of 20 individuals suffering from bruxism were selected from the Outpatient Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, Mysore. Saliva samples were collected before and after using the occlusal soft splints and subjected to enzyme-linked immunosorbent assay for determining the salivary cortisol levels.Results:The collected data were subjected to appropriate descriptive statistics, paired sample t-test, and one sample t-test. The paired sample t-test shows that intragroup comparison of the mean cortisol level in the study group shows near significant values, which means there is a decrease in the salivary cortisol levels in patients after using soft occlusal splint, but statistically nonsignificant.Conclusion:In the present study, it has been found that 70% of individuals after using the soft occlusal splint showed decreased cortisol levels.

Sleep bruxism and sleep disorders in adolescents

Sleep Bruxism, the sleep-related movement disorder of tooth grinding and clenching, is highly reported in pediatrics with a prevalence of up to 40 % during childhood and adolescence. The precise etiology of sleep bruxism remains unknown, but it may involve genetic and psychosocial components (such as anxiety and stress). Clinicians should be aware that quite often sleep bruxism is associated with other disorders, such as snoring, sleep-disordered breathing, sleep complaints, and behavioral problems. These comorbidities should be investigated, because they may be severe and prolonged if they are not treated. SB may lead to morning jaw muscle soreness or pain, headache, masticatory muscle hypertrophy, temporomandibular disorders, and tooth wear. Especially in pediatrics, sleep bruxism is usually managed with conservative therapies, such as sleep hygiene, behavioral modifications, biofeedback, familial counseling and, only in cases of severe tooth wear or other serious possible consequences of SB, soft occlusal splints.

Role of soft occlusal splint therapy in the management of temporomandibular disorders: A 6-month follow-up study

Objective: To analyze the effectiveness of soft occlusal splint therapy in patients presenting with temporomandibular disorders (TMDs) in each diagnostic category based on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. Materials and Methods: In this study, 50 consecutive patients (20 males and 30 females) with TMDs received soft occlusal splint therapy. All the patients were evaluated for temporomandibular joint (TMJ) pain on visual analog scale (VAS), maximum comfortable mouth opening or interincisal distance (IID), and joint sounds at the time of diagnosis and after every month for the next 6-month period. Pre- and post-treatment clinical parameters were compared using paired and unpaired t-tests, and Kruskal–Wallis test. Results: At 6 months' follow-up examinations, there was a progressive decrease in pain and tenderness as indicated by VAS scores and significant improvement in mouth opening (mean IID) after treatment with soft occlusal splint therapy. The joint sounds were either ceased completely or reduced in intensity. Conclusion: Within the limitations of this study, we can conclude that soft occlusal splint therapy is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders.

NONSURGICAL CLOSURE OF OROANTRAL COMMUNICATIONS USING OCCLUSAL SPLINTS

Purpose: Oroantral communications (OACs) may close spontaneously, especially when the defect has a size smaller than 2-3 mm, whereas larger openings require surgical closure. The aim of this retrospective study was to present our experince with non surgical closure of small and large OACs with occlusal splints. Materials and Methods: Clinical and radiographic data of twenty patients who had used occlusal splints after the occurance of an acute OAC were included in this study. Two groups were created according to the size of the defects: Group A: defects smaller (<) than 5 mm; and Group B: 5 mm and wider (≥). In all patients, a well fitted soft occlusal splint was placed for hermetic closure of the opening. All patients were followed up weekly and the splint use was stopped when complete epithelization of the OAC was observed clinically. T he relationship between the size of OACs, treatment outcome, and healing time was compared statistically. Results: OAC was healed spontaneously in all patients, except one. The healing time was found to be significantly higher in goup B than in group A. No significant difference was found between the groups with respect to the success of the treatment. Conclusion: The use of occlusal splints seems to improve the spontaneus healing of the OACs.