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Objectives: Objectives: There are few treatment options for treating symptoms of temporomandibular disorders and also for bruxism. Occlusal stabilization splints are most frequently used. The purpose of present study was to determine Croatian dental practitioners’ knowledge and attitudes about stabilization splint therapy. Methods: Methods: An online questionnaire was sent (using e-mail) to a Croatian dentists’ database. Questionnaire had 22 questions that aimed to specify Croatian dentists’ knowledge, attitudes and practice with occlusal and stabilization splints therapy. Results: Results: A total of 296 dentists filled out the questionnaire. The two most common indications for occlusal splint therapy were bruxism (79.5%) and pain or disfunction of the temporomandibular joint (41%). Most of participants (49.4%) are using both soft and hard (acrylic) splints, 29.6% are using only acrylic splints, 15.8% are using only soft splints, while 5.3% is not certain about used occlusal splint material. Over 65% of participants responded that they do not know what is stabilization splint or that are not sufficiently informed about it. Still, 89.3% of participants recommend stabilization splints to their patients. Conclusions: Conclusion: Most frequent indication for occlusal splint therapy among Croatian dentist was bruxism. As most participants considered that they are insufficiently informed about stabilization splits there is a need for motivation and additional education about occlusal splint indications and therapy.

Stabilization splint is frequently used therapy for temporomandibular disorders and bruxism. Few data exist regarding dental practitioners’ behavior with stabilization splint therapy. The purpose of this study was to examine dental practitioners’ awareness about occlusal stabilization) splints. In this cross-sectional study, an online questionnaire was administered via e-mail to a dentists’ database (Croatian). Questionnaire consisted of 22 questions which aimed to specify Croatian dentists’ knowledge, attitudes and practice with occlusal and stabilization splints therapy. A total of 296 dentists filled out the questionnaire. Most frequent indications for occlusal splint therapy were bruxism (79.5%) and pain or disfunction of the temporomandibular joint (41%). Most of participants (49.4%) are using both soft and hard (acrylic) splints, 29.6% are using only acrylic splints, 15.8% are using only soft splints, while 5.3% is not certain about used occlusal splint material. Over 65% of participants responded that they do not know what is stabilization splint or that are not sufficiently informed about it. Still, 89.3% of participants recommend stabilization splints to their patients. Most frequent indication for occlusal splint therapy among Croatian dentist was bruxism. As most participants considered that they are insufficiently informed about stabilization splits there is a need for motivation and additional education about occlusal splint indications and therapy.

Svrha rada: Svrha ovog pilot-istraživanja bila je ispitati utjecaj terapije okluzijskom udlagom na granične kretnje donje čeljusti te položaj kondila kod ispitanika s bruksizmom. Materijal i postupci: U istraživanje je bilo uključeno 9 ispitanika s dijagnosticiranim bruksizmom (srednja dob 28,7 godina) i 9 ispitanika u kontrolnoj skupini (srednja dob 30,5 godina). Svi su bili punoljetni, eugnati s dentoalveolarnom klasom I prema Angleu, bez postojećih protetičkih radova, bez prijašnje ili sadašnje ortodontske terapije, prijašnjih kirurških zahvata u području temporomandibularnog zgloba te bez neke sistemske bolesti. Za sve ispitanike u objema skupinama izrađena je relaksacijska okluzijska udlaga standardiziranim postupkom koju su nosili 8 tjedana. Za to su vrijeme obavljena, uz inicijalno, još 3 mjerenja incizalnog otvaranja (IO), otvaranja lijevog kondila (OLC), otvaranja desnog kondila (ORC), lijeve laterotruzije (LLI) i desne laterotruzije (LRI) (nakon 2, 4 i 8 tjedana), koristeći se ultrazvučnim uređajem za snimanje kretnji donje čeljusti Arcus Digma II (Kavo). Istim uređajem ispitana je promjena položaja kondila pri protruziji, lijeve i desne laterotruzije te u položaju centrične relacije (CR) na početku istraživanja i zatim nakon 8 tjedana koristeći se položajem maksimalne interkuspidacije kao referentnim. Kontinuirane varijable opisane su s pomoću osnovnih statističkih parametara, a statistička značajnost razlika između varijabli provjerena je t-testom i χ2 testom (p < 0,05). Rezultati: Vrijednosti za IO, OLC, ORC, LLI LRI povećane su nakon 8-tjednog nošenja udlage te je najveće povećanje zabilježeno kod OLC-a –- za 13,8 %. Ni za jednu promjenu iznosa graničnih kretnji nije utvrđena statistički značajna razlika (p < 0,05). Promjene položaja kondila pri protruziji, lijeve i desne laterotruzije te u položaju centrične relacije (CR) bile su veće u ispitnoj skupini u 10 od 14 mjerenih parametara u odnosu prema kontrolnoj skupini te je u 5 od 14 mjernih parametara ustanovljena statistič-ki značajna razlika nakon terapije udlagom. Zaključak: U ovom pilot-istraživanju dokazan je utjecaj terapije udlagom na granične kretnje mandibule kod ispitanika s bruksizmom povećanjem raspona kretnji. Također je utvrđena veća promjena položaja kondila kod ispitanika s bruksizmom u odnosu prema zdravima., Objective: The objective of this pilot study was to examine the impact of occlusal splint treatment on mandibular border movements and the condyle position in subjects with bruxism. Material and methods: The study included 9 subjects diagnosed with bruxism (mean age 28.7) and 9 subjects in the control group (mean age 30.5). All subjects were adults, eugnathic, and with a dentoalveolar Angle Class I, without prosthetic restorations, previous or current orthodontic treatments, a systemic disease or previous surgical interventions in the temporomandibular joint. All experimental and con-trol group subjects were provided with a standardized relaxation occlusal splint, which they wore for 8 weeks. During this time, an initial and three additional measurements of incisal opening (IO), left condyle opening (OLC), right condyle opening (ORC), left laterotrusion (LLI) and right laterotrusion (LRI) (after 2, 4 and 8 weeks) were performed using an Arcus Digamma II (Kavo) ultrasound device for mandibular movements recording. Using the same instrument, the condylar position during protrusion, left and right laterotrusion, and in the centric relation position (CR) was analyzed initially and after 8 weeks using the maximum intercuspation as reference point. Continuous variables were described using basic statistical parameters, and the statistical significance of differences between the variables was checked by the t-test and χ2 test (p

Objectives Temporomandibular disorders have high prevalence in general population. Data about temporomandibular disorders among different types of contact sports athletes are scarce. The objective of this study was to analyze association between self-reported temporomandibular dysfunctions and combat sports training. Methods This study included 57 participants who were trained/training combat sports. Twenty four participants were practicing boxing, 12 mixed martial arts, 11 kickboxing, and 10 participants were practicing other types of combat sports. All participants filled out the online questionnaire which was sent to different combat sports clubs in Croatia, which forwarded the questionnaire to its club members. Results Eighteen participants responded that they had previous temporomandibular joint trauma, 29 had not, while 10 was not sure about past temporomandibular joint trauma during sports practicing. Thirty-three participants experienced pain in temporomandibular joint during or after sports practicing. Forty-two participants reported previous pain at opening/closing of the mouth during or after sports practicing. Twenty-nine participants experienced muscle tenderness associated with opening and closing of the mouth during or after sports practicing. Sixteen participants had limited mouth opening during or after sports practicing. Sixteen participants associated disc dislocation and/or crepitus in temporomandibular joint with previous trauma during combat sports training. Conclusions Almost every participant experienced some symptom or sign of the temporomandibular dysfunctions. Combat sports training could have its influence on the temporomandibular joint health. More frequent visits to the dentists of the combat sports athletes could be recommended.

Background: Bruxism and muscular temporomandibular dysfunctions (TMD) are common in patients and are considered as a contraindication for implant prosthetic treatment. The reason for this is a high percentage of implant failure, as well as biological and technical failures on implant-retained prosthetic restorations. The standard treatment in patients diagnosed with bruxism and muscular TMD includes fabrication of an occlusal splint, which should be made of a suitable material with a precise fit and allow precise occlusal contacts. Aim of the study: The purpose of this paper is to present two clinical cases indicating benefits of CAD/CAM occlusal splint fabrication immediately after implant prosthetic treatment, as an everyday procedure for the purpose of extending implant life and reducing the possibility of biological and mechanical failures of implant-retained prosthetic restorations. Materials and methods: Bruxism and muscular TMD were diagnosed in the two patients by means of clinical functional analysis before the implant treatment. Implant-retained prosthetic restorations were made and fabrication of an occlusal splint was initiated. Impressions of the upper and lower jaw were taken for fabrication of dental stone casts. Interarch relationships were registered using the face bow and centric registration, and eccentric registrations were taken for articulator individualization. The occlusal splint was fabricated by means of the Ceramill CAD/CAM system (AG, Germany). The casts were first scanned in the Map scanner in the real interarch relationships, and they were transferred in the Mind software to the individualized virtual articulator. The occlusal splint was designed in the M-Splint software, first its shape, and then its occlusal surfaces, by creating static and dynamic occlusal contacts. The final design of the splint was milled from the Splintec PMMA material in the Motion 2 milling machine. The fabricated CAD/CAM splint was checked in the articulator and handed in to the patient, together with its fit and occlusal contacts checking. Results: In relation to the fabrication of occlusal splints by means of standard procedures of flasking and polymerization, occlusal splints from transparent PMMA material can be fabricated without contractions using the CAD/CAM system. This enables their excellent retention and stabilization, as well as precise planning and occlusal contacts fabrication. One to two occlusal contacts per a pair of antagonists were established in static occlusion, while contacts according to the concept of canine guided occlusion were established in dynamic occlusion. Four years after the fabrication of implant-retained prosthetic restorations, the two patients had no radioopaque bone loss around the implant, nor biological and technical deficiencies on implant-retained prosthetic restorations. Conclusions and clinical implications: Beside planning of the position of dental implant placement and correct surgical and prosthetic methods in fabrication of implant-retained prosthetic restorations, it is important for patients diagnosed with bruxism or muscular TMD to receive a precise occlusal splint immediately after the implant- prosthetic treatment is finished, in order to prolong the life expectancy of the implant and reduce the possibility of occurrence of biological and technical failures.

The objective of this in vitro study was to compare microtensile bond strength of fiber reinforced composite and particulate filler composite to coronal and pulp chamber floor dentin using self- etching adhesive system. Forty human molar teeth, were divided into two experimental groups (n = 20 per group). In the first group, coronal dentin was exposed by cutting of occlusal enamel with the Isomet saw. In the second group, pulp chamber floor dentin was exposed by trepanation, after which chemo- mechanical instrumentation and root canal filling were performed. These two groups were further subdivided into two groups (n=10) according to the type of composite: fiber reinforced composite (everX Posterior, GC, Tokyo, Japan, ) and particulate filler composite (G- aenial Posterior, GC, Tokyo, Japan). A self-etching adhesive system (G-aenial Bond, GC, Tokyo, Japan) was used for all specimens. In the group with exposed coronal dentin, 5 mm high composite blocks were built up with each of the tested composites. In the group with exposed pulp chamber floor dentin, composite resin blocks were built to the level of occlusal surface. Each specimen was serially sectioned to obtain sticks with a cross- sectional area of 1 mm2, and microtensile bond strength test was performed (Figure 1). Statistical analysis was performed using one-way ANOVA test at level of significance set at 5%. Microtensile bond strength values were significantly higher for coronal dentin in comparison to pulp chamber floor dentin (p0.05), (Figure 2). Only the adhesive type of failure was observed in all four experimental groups. Higher microtensile bond strength values were observed for coronal dentin than for pulp chamber floor dentin. Fiber reinforeced and particulate filler composite performed similarly regarding the microtensile bond strength.

TMJ disorder is an umbrella term for several TMJ diagnoses, the most common being osteoarthritis (OA) and disc displacement (DD). Apart from the musculoskeletal pain of the orofacial region, headaches are the most common neurological pain. Also, musculoskeletal diseases can develop in other anatomically-topographically approximate areas, particularly in the form of cervicogenic and cervicocephalic syndromes. Clinical diagnostics of TMJ disorders are related to the existence of another type of headache, particularly since a special diagnosis of TMJ- related headache according to research criteria for temporomandibular disorders (RC/TMD) was introduced.

Partial articular disc displacement in patients with TMJ disorder

Temporomandibular pain has a musculoskeletal origin because it occurs as a consequence of masticatory muscles function disorder and temporomandibular joint disorder. Most common diagnoses of disorders are disc displacement and osteoarthritis, but their co- morbidity can also occur. Pain is most common symptom, where chronic temporomandibular pain may contribute to the occurrence of psychological disorders in patient population. The splint is the most widespread dental method of treatment but other, noninvasive methods of musculoskeletal pain treatment are also recommended. For the purpose of visualization of mandibular movements, and particularly pathological sounds in the joints, electronic axiography is used. Mental health, although this is not so obvious in dental practice, can affect the need of a multidisciplinary approach to a patient with disorder of the temporomandibular joint.

Objective: The purpose of this study was to determine the effect of occlusal splint on mandibular range of movements in individuals with bruxism. Method: Nine individuals with diagnosed bruxism and no signs and symptoms of TMD were included in this pilot study. An occlusal relaxation splint was made by a standardized procedure in a fully adjustable articulator (Protar Evo 7, Kavo, Germany) for each subject. Recordings for fabrication of splints and for mandibular range of movements were obtained by an electronic ultrasound measuring device (Arcus Digma II, Kavo, Germany), by using the kinematic axis as the posterior reference point. Measurements were made initially and after 2, 4, 8 and 12 weeks of wearing the splint. Each subject performed opening and closing, laterotrusion to the left and right and Posselt`s movement in the sagittal and horizontal axis, based on which opening incisal, opening left condyle, opening right condyle, laterotrusion left and laterotrusion right were calculated as parameters for mandibular range of movements. Result: The mean values of all tested variables increased slightly with increasing of the follow-up time. Laterotrusion left had the highest and opening right condyle the lowest increase. The results of variance analysis showed no statistically significant difference among the groups of the tested parameters at the significance level of p

Background: Although implants are widely used in everyday practice there are insufficient data on the type of suprastructure fixation (screw versus cement) of the prosthetic appliance and presence of microbial species. Aim: The aim of the study was to analyse the relationship between the type of prosthetic suprastructure fixation (screwed or cemented) and the presence of A. actinomycetemcommitans, P. gingivalis, T. forsythia, P. intermedia, T. denticola and F. nucleatum. Furthermore, the aim of this study was to evaluate possible correlation between the presence of systemic diseases and the type of the investigated bacteria. Materials and Methods: In fifty one dentate patient, 136 implants were inserted either in the upper or lower jaw in the place where molars were missing. Cemented suprastructure was put in 32 patients and screw retained suprastructure in 19 patients. Samples were taken with sterile paper points before abutment fixation and six months later (three times during ten seconds from the gingival sulcus) and analyzed with real-time polymerase chain reaction. Plaque index, Papillla bleeding index and Community Periodontal Treatment Need Index as well as the presence of systemic diseases was recorded. Shapiro – Wilks test was used when samples were smaller than 30 and Kolmogorov – Smirnov test when they were more than 30. P value under 0.05 was significant. No differences in the presence of A. actinomycetemcommitans, P. gingivalis, T. forsythia, P. intermedia, T. denticola and F. nucleatum with regard to the type of fixation (screwed versus cemented) were seen. There was a significant increase in bacterial count in persons with cardiovascular, rheumatic diseases and in those who took medications and were older. Preoperatively, there was no correlation between periodontal pocket depth with the number of the bacteria. Postoperatively, patients with more periodontal pockets of ≥4 mm harvested higher number of investigated bacteria.

The reported case is of a 36-year-old female patient who was selected from a group of consecutively collected patients with temporomandibular disorders in the period between 2001 and 2011. Diagnostics included a clinical examination and the use of manual functional analysis. A positive finding was compared with magnetic resonance as the gold standard. In patients with pronounced clinical symptoms of osteoarthritis, computerized tomography was also used. The treatment implied fabrication of a Michigan splint. Electronic axiography was used to visualize mandibular movements - Arcus Digma II (KaVo Dental). The patient’s ailments started 15 years ago when she had the first limitations in mouth opening in the left temporomandibular joint (TMJ) and strong pain, which would subside after 10-15 minutes. She has suffered from bipolar disorder for years, which started as an unrecognized postpartum depression. She had healthy teeth with pronounced facets due to bruxism, which she confirmed during the interview. On the visual analogue scale (VAS=0-10), she rated the pain in the left TMJ 5.5 and pain on palpation 7.5. Pain with limited opening in the left and crepitation with pain (VAS=4) in the right joint were determined by dynamic compression. Radiologic diagnostics showed anterior disc displacement (DD) without reduction in the left and with reduction in the right TMJ. The left TMJ had an osteophyte with degenerative subchondral changes. The STAI test by Spielberger determined a high level of anxiety about the current condition and personality issues. There was no remission of pain during the follow-up of three years. The ‘motion analysis’ module confirmed clicking in the right TMJ at 15.5 mm of condylar movement on the articular eminence. Although the crepitation disappeared with time, asymptomatic DD in the right TMJ caused an atypical and clinically pronounced clicking. Mental health, although unnoticed in dental practice, can affect bruxism prevention.