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Objective: To evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD). Methods: One-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey’s HSD, and chi-square tests (alpha = 0.05). Results: At T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05). Conclusions: The short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month. Clinical Relevance: Earplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured. Materials and methods: The protocol was registered online at Open Science Framework (OSF) registries () and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022. Inclusion criteria: in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2 = 0%, while statistical analysis was conducted using a random-effects model with I2 > 0%. Results: 13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge’s g with 95% CI = -1.25[ -1.84, − 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge’s g with 95% CI = -0.01 [-2.71, − 2.68]). While flexural strength was higher in the control group (Hedge’s g with 95% CI = 2.32 [0.10–4.53]). Conclusion: 3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials. Clinical relevance: The use of “mixed splints” combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties. [ABSTRACT FROM AUTHOR]

Objectives: This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially available denture cleaning tablet immersion simulation. Materials and methods: Disc-shaped additively manufactured and hand-cast auto polymerizing acrylic resin specimens were prepared (N = 40 each). All specimens were exposed to coffee solution totally 2 days. Thereafter, all specimens were immersed into three different effervescent solutions that simulated 6 months of clinical use. The total color change (ΔE*ab), surface roughness (Ra), and Vickers hardness (Vh) were measured at baseline and after immersion protocols. A two-way ANOVA and Bonferroni’s post hoc test were used for color change. The dependent t-test and ANOVA were used for roughness and hardness evaluation. Results: Additively manufactured splint materials were more affected by coffee immersion. It was observed that all denture cleaning tablets induced a noticeable alteration in color of the specimens (p < 0.05). Roughness and hardness measurement changes after solution immersions were statistically significant for both splint groups (p < 0.05). On the other hand, distilled water and denture cleaning tablets created similar roughness and hardness measurements at baseline and after immersion. Conclusions: After 6 months use of tested cleaning tables, the color stability, surface roughness, and hardness of both groups were affected. The evaluation of the surface properties of splint materials could be recommended to the dentists in periodic controls during splint treatments. Clinical relevance: The use effervescent denture cleaning tablets altered the surface characteristics of tested splint materials over time with nonsignificant difference between each other. After 6 months, awareness should be raised about surface characteristics of splint materials. [ABSTRACT FROM AUTHOR]

Objectives: This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers. Materials and methods: A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA. Results: There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05). Conclusions: Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox. Clinical relevance: Both splint and botox treatments were effective for bruxism by reducing the stress levels. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Material and Methods: A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. Results: The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46–0.74, range 0.32–1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44–1.28, range 0.09–2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. Conclusions: Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. Clinical relevance: Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines. [ABSTRACT FROM AUTHOR]

Objectives: Sleep bruxism (SB) is associated with physiological activities including sympathetic autonomic system dominance and sleep micro-arousal. While oral appliances (OA) are used to prevent SB harmful effects, the influence of OAs physiological mechanisms during sleep is unknown. The aim of this study is to assess whether heart rate variability (HRV) changes, as a marker of autonomic nervous system activity, would be associated with the OA mechanism of action on SB using occlusal splint (OS) and mandibular advancement splint (MAS). Materials and methods: A retrospective analysis, from data previously collected in 21 participants with SB (25.6 ± 4.5 years) with polysomnographic recordings, was done. HRV data were compared between a reference night (no-device) and ones during which OS or MAS was used in a crossover study design. Rhythmic masticatory muscle activity (RMMA) index was compared between nights. HRV was evaluated using autoregressive model analysis for three sections: baseline (distance from RMMA), immediately before, and after RMMA period. Results: A significant reduction in RMMA index, when wearing OA during sleep, was observed (P < 0.01), but was not associated with HRV parameters change. HRV significantly changed after RMMA onset for nights with OA during non-REM sleep in comparison with baseline (P < 0.02). Conclusions: The usage of OAs for SB participants reduced RMMA, but most likely independently of changes in HRV linked to the mechanism associated with SB genesis. Clinical relevance: Wearing OA seems to reduce grinding noise and protect from dental injuries but does not seem to influence SB genesis. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS). Materials and methods: Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms. Results: The BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients' global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts. Conclusions: The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline. Clinical relevance: By reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients' physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint. The universal trial number: U1111-1239-2450 DRKS-ID registration: DRKS00018092 [ABSTRACT FROM AUTHOR]

Objectives: This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially available denture cleaning tablet immersion simulation., Materials and Methods: Disc-shaped additively manufactured and hand-cast auto polymerizing acrylic resin specimens were prepared (N = 40 each). All specimens were exposed to coffee solution totally 2 days. Thereafter, all specimens were immersed into three different effervescent solutions that simulated 6 months of clinical use. The total color change (ΔE* ab ), surface roughness (R a ), and Vickers hardness (V h ) were measured at baseline and after immersion protocols. A two-way ANOVA and Bonferroni's post hoc test were used for color change. The dependent t-test and ANOVA were used for roughness and hardness evaluation., Results: Additively manufactured splint materials were more affected by coffee immersion. It was observed that all denture cleaning tablets induced a noticeable alteration in color of the specimens (p < 0.05). Roughness and hardness measurement changes after solution immersions were statistically significant for both splint groups (p < 0.05). On the other hand, distilled water and denture cleaning tablets created similar roughness and hardness measurements at baseline and after immersion., Conclusions: After 6 months use of tested cleaning tables, the color stability, surface roughness, and hardness of both groups were affected. The evaluation of the surface properties of splint materials could be recommended to the dentists in periodic controls during splint treatments., Clinical Relevance: The use effervescent denture cleaning tablets altered the surface characteristics of tested splint materials over time with nonsignificant difference between each other. After 6 months, awareness should be raised about surface characteristics of splint materials., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers., Materials and Methods: A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA., Results: There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05)., Conclusions: Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox., Clinical Relevance: Both splint and botox treatments were effective for bruxism by reducing the stress levels., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)