Soft Splint Research Articles

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

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

OP0076-HPR Effects of a soft thumb base splint in persons with carpometacarpal osteoarthritis: A randomised controlled trial

BackgroundHand osteoarthritis (HOA) typically involves the distal interphalangeal joints the proximal interphalangeal joints, and the first carpometacarpal (CMC1) joint. Common functional consequences are pain, reduced hand mobility and grip force,...

Influence of periodontal ligament simulation and splints on strains developing at the cervical area of a tooth crown

Many in vitro tooth models do not incorporate periodontal ligament (PDL) simulation. This study presents the influence of physiologically loaded occlusal splints on cervical strains in a model incorporating roots and PDL. Four sets (N = 10) of occlusal splints differing in material (hard/soft) and location (upper/lower) were prepared for first maxillary and mandibular anatomic molars. Two strain gauges were bonded to the buccal and lingual aspects of the lower molar. Teeth were embedded in acrylic resin with/without a PDL-simulating material. Force vs. strain data were acquired during loading and the maximal strains at 500 N were analyzed. When PDL was incorporated into the model without splints, buccal compressive strains were significantly decreased. Usage of a soft splint resulted in compressive strains on both tooth aspects. Usage of a hard splint on the lower tooth resulted in higher compressive strains on the lingual side compared with the buccal side, whereas usage of this splint on the upper tooth resulted in tensile strains on the lingual side. Bending towards the buccal side occurred when the splints were located on the upper tooth. Soft splints reduce buccal bending, but do not reduce cervical strains. Periodontal ligament stimulation materials should therefore be incorporated in models involving teeth.

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

Pemphigus Vulgaris: Application of Occlusal Soft Splint with Topical Steroid in the Treatment

Pemphigus vulgaris (PV) is a rare autoimmune bullous dermatosis with a high mortality rate if untreated. It is characterized by the binding of IgG autoantibodies to desmogleins 3 (DSG 3), a transmembrane glycoprotein adhesion molecule present on desmosomes. This glycoprotein strengthens the intercellular connection, and loss of this connection due to the antigen-antibody reaction weakens and finally breaks the connection between epithelial cells resulting in blisters and desquamation. Patients with PV mainly involving the mucosa have antibodies directed against DSG 3, but patients with PV involving both the skin and mucosa will have antibodies against both DSG 3 and DSG 1. Most patients are initially misdiagnosed and improperly treated for many months or even years. Dental professionals must be sufficiently familiar with the clinical manifestations of PV to ensure early diagnosis and treatment, since this in turn determines the prognosis and course of the disease.

Eight Questions on Intraoral Splint Concepts: an Interview with Prof. Rudolf Slavicek

1. What do you think of a soft splint versus hard resin? RS: My viewpoint is based on the fact that teeth are hard structures. Therefore it makes sense to adhere as closely as possible to this fact when using a splint. A soft splint does not reduce muscle activity, but induces permanent movements. One explanation for the therapeutic mechanism of splints is the pacification of musculature. I personally believe that soft splints are contraindicated. 2. What are your recommendations about the anterior occlusal stop (like some pre-fabricated products)? RS: There is an old rule: hyperactive musculature and especially conditions associated with painful joints cannot be treated with anterior occlusal stops alone. Such devices are contraindicatedinthesecircumstances.TheShorePlate,asa typical example of an anterior occlusal stop device, is designed with an anterior stop and no lateral support. Another concept was the Schulte Interceptor. However, Schulte demands exact observation of the jaw joints – he always warns against the possibility of joint compression. Besides, he limited the use of this device to a maximum of one week. New devices equipped merely with a small anterior support are now available in the market. They may be indicated for short-term deprogramming but how does one prevent the patient from swallowing this little object? Of course an overloadoftheanteriorteethisfeasible.InanycaseIstrongly recommend adherence to Schulte’s rules: temporary therapeutic application and exact observation of the course of treatment. 3. What are your indications for a splint? RS: First, reduction of muscle activity. Such splints are known as Relaxation Splints or Myopathy Splints. Second, unloading joint structures. I do not use the term “decompression” in such situations. It’s not active distraction. Rather, it signifies a release of joint structures. The joint is moved forward and to a small extent downward. Third, a verticalisation splint in those cases in which verticalisation is indicated. The last indication is joint reduction using the so-called reduction splint. The use of such devices has declined in recent years. A discus in good shape and condition is a precondition for the use of such splints with the mandible in protruded position. A new approach to reduction splints is the Delta Y splint introduced by Alain Landry from Canada. Delta Y is defined as transverse displacement of the mandible to the left or the right. This shift must be taken into consideration and appears to be an important diagnostic finding. It exerts a significant impact on the success of a splint. I really do think this approach will increase the success rate in patients with lateral displacement of the mandible.

A case report on the remodelling technique for the earlobe using a soft splint

Correcting earlobe deformities often presents an aesthetic challenge to the surgeon. The described technique presents a simple, accurate and cost effective method of remodelling soft tissue defects of the earlobe using a soft splint.

Brain activities during maximum voluntary clenching with and without soft splint in patients with hemimasticatory spasms by functional magnetic resonance imaging

Functional magnetic resonance imaging (fMRI) was used to detect the cerebral cortical somatotopy during maximum voluntary clenching with and without soft splint in patients with hemimasticatory spasms (HMS) and the central mechanisms of HMS and the rule of the splint therapy. Four HMS patients were selected and the spasms sides were right in two cases and left in the other two cases. FMRI images were obtained on Elscint/GE 2.0 Tesla MR system. Block design was used and the movement pattern was the onset of spasms after maximum voluntary clenching with and without soft splint. The fMRI data were analyzed by SPM99 software. With the onset of spasms after maximum voluntary clenching, the activation of motor cortex in 3 HMS patients was found lateral dominance on the left side, and the other one showed bilateral activation. All the 4 patients were found activation in cingulate area. With the onset of spasms after maximum clenching wearing soft splints, the activation of motor cortex showed no lateral dominance on the left side, and 3 patients were not found activation in cingulate area. The changes of the activation in motor cortex and cingulate area during the onset of spasms after clenching with and without soft splint might be the central mechanisms of the rule of splint therapy, through which the soft splint might function in alleviating muscle pain.

Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review.

This study aimed at providing an answer to two clinical questions related to patients with masticatory muscle pain: 1) Does the use of a full-coverage hard acrylic occlusal appliance (stabilization splint) lead to a significant decrease of symptoms? and 2) Is the treatment success achieved with a stabilization splint more pronounced than the success attained with other forms of treatment (including placebo treatment) or no treatment? A systematic search was carried out in different electronic databases, supplemented by handsearch in four selected dental journals and by examination of the bibliographies of the retrieved articles. Thirteen publications, representing nine controlled clinical studies, could be identified. Reporting quality of most studies as assessed with the Jadad score ranged from 1 to 5. Based on the currently best available evidence it appears that most patients with masticatory muscle pain are helped by the incorporation of a stabilization splint. Nevertheless, evidence is equivocal if improvement of pain symptoms after incorporation of the intraoral appliance is caused by a specific effect of the appliance. A stabilization splint does not appear to yield a better clinical outcome than a soft splint, a non-occluding palatal splint, physical therapy, or body acupuncture. The scarcity of current external evidence emphasizes the need for more and better clinical research.

C OMPARISON OF P ERCEIVED P AIN WITH D IFFERENT I MMOBILIZATION T ECHNIQUES

Objective. To compare the locations and severities of pain generated by a hard wooden spine board vs a soft vacuum mattress splint on immobilized volunteers. Methods. This was a prospective randomized crossover study conducted in an emergency medical services (EMS) classroom within a university teaching hospital. Participants were 18 healthy volunteers with no history of acute or chronic back pain, pregnancy, or recent analgesic use. The subjects were placed in one of three immobilization boards (hard spine board and two different vacuum splint models, identified as red and blue) for 60 minutes. At 0, 30, and 60 minutes the subjects rated their pain at multiple locations on their body using a visual analog scale (VAS). After a two-day washout period, this procedure was repeated on a different board and later a third board until all the subjects had been tested on all three boards. Results. Although many pressure point locations were studied, only three had results that appeared statistically significant: the occiput, lower back, and sacrum. The hard spine board had higher mean pain scores as well as a higher percentage of subjects who reported any pain when compared with the two vacuum mattress splints. Mean scores for the 30- and 60-minute times were: occiput 2.06 and 2.78 for the hard board compared with 0.78 and 0.56 for red and 0.44 and 0.67 for blue; lower back 1.39 and 1.44 for the hard board compared with 0.28 and 1.11 for red and 0.06 and 0.17 for blue; and sacrum 1.56 and 2.06 for the hard board compared with 0.33 and 0.39 for red and 0.89 and 1.06 for blue. Conclusion. The hard-board method of spinal immobilization generates higher self-reported pain scale scores than the two vacuum mattresses.

A SIMPLE TECHNIQUE FOR ADJUSTING AND POLISHING A SOFT SPLINT

Soft splints are often fabricated from a thermoplastic vinyl sheet 0.15 inch (3.8 millimeters) thick. Some practitioners report that soft splints are difficult or nearly impossible to adjust, while it has been speculated that the soft splint’s efficacy may be related to how well its occlusion is adjusted. This article describes a technique for adjusting a soft splint easily, using its thermoplastic property to greatly shorten the time needed for the adjustment.

An Evaluation of the Soft Splint in the Acute Management of Elbow Hypertonicity

This paper presents an evaluation of the Soft Splint used in the management of hypertonicity at the elbow. An “A1,B1,A2,B2” single system design was used with elbow range of motion, measured with a standard goniometer, as the dependent variable. Visual analysis of the data and the two standard deviation band method of data analysis indicated that the Soft Splint is highly effective in the management of hypertonicity. Elbow range of motion improved significantly during the intervention phases. During the A2 (non-intervention) phase the measurements returned to the baseline level. The findings support the continuing use of the Soft Splint in reducing hypertonicity at the elbow. Replication of this design is required to generalize the results of this study.

A New Protective Soft Splint for Contact Sports

Athletes who sustain metacarpal injuries such as nondisplaced and minimally displaced fractures or metacarpophalangeal dislocation have benefited from the use of a newly developed Plastizote hand/wrist orthotic device. This orthosis allows appropriate immobilization as well as early, safe, and effective return to contact sports during the healing process. Three case reports are presented along with applications and methods for fabricating this lightweight splint.

Update in Splinting Materials and Methods

Current hand splinting methods, materials, and components are reviewed and summarized. Additional subjective and objective tests of thermoplastic materials are performed and results combined with those from other studies. Available samples of thermoplastic materials are tested for fatigue and viscoelastic properties using standard compression cycling methods. Soft splint materials are seeing increased application and appear to be the material for the future.

The Use of the Soft Splint in the Management of Spasticity of the Upper Limb

The Soft Splint is a cylindrical foam splint first developed for use by Anderson, Snow, Dorey and Kabo (1988) to reduce knee contractures. The splint has been adapted for use with the upper limbs. This article describes the fabrication of the Soft Splint and its utilisation with clients with increased tone of the upper limb. The rationale for use of the Soft Splint is supported by the literature which has been reviewed in this article. Further research is required into the most effective utilisation of the Soft Splint; however, it is proving to be a valuable splint in the management of increased tone in the upper limb.

Percutaneous pyeloplasty: an alternative to open surgery

This paper describes the management of five patients with pelviureteric junctional obstruction who were treated by a one-stage percutaneous procedure. In two patients, renal calculi were removed simultaneously. The obstructing strictured area was divided internally by means of a modified endoscopic urethrotomy knife, which was passed through a percutaneous nephrostomy track. The defect was bridged by natural regeneration around a soft splint over six weeks. Four patients achieved a successful result with a shortened hospital stay, minimal morbidity, improved radiological drainage and the avoidance of open surgery. One patient, who had undergone three previous open plastic operations, was still symptomatic, in spite of successful anatomical correction. At exploration, open surgical repair was impossible and a nephrectomy was performed. This new technique appears applicable to selected primary and secondary pelviureteric junctional obstructions in which the obstructing segment is in an anatomically dependent situation.

Soft playing splint for protection of significant hand and wrist injuries in sports.

A simple custom-made soft splint has been devised to allow safe sports participation for significant hand and wrist injuries. Made from readily available materials, this "rubber splint" has been used successfully in 113 injuries reviewed in this report. This splint is a result of a modification of an original "Duke" splint described by Dobson, Davis, Lincoln, and Basset, (Exhibit at American Academy of Orthopaedic Surgeons, San Francisco, California, 1971) and the soft cast used at the University of Virginia by McCue and Gieck (personal communication).